Health Services Commissioner Annual Report 2000/2001
Health Services Commissioner Annual Report 2000/2001
Health Services Commissioner Annual Report 2000/2001
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<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong><br />
<strong>Annual</strong> <strong>Report</strong><br />
<strong>2000</strong>/<strong>2001</strong>
TABLE OF CONTENTS<br />
COMMISSIONER’S SUMMARY.........................................................................................3<br />
HEALTH SERVICES REVIEW COUNCIL PRESIDENT’S REPORT <strong>2000</strong>/<strong>2001</strong> ................6<br />
STATUTORY FUNCTIONS ..............................................................................................10<br />
THE ROLE OF THE COMMISSIONER....................................................................................................10<br />
GUIDING PRINCIPLES ................................................................................................................................10<br />
EXPECTATIONS AND STANDARDS......................................................................................................11<br />
OTHER STATUTORY ROLES....................................................................................................................11<br />
LIAISON, TRAINING & PROMOTION....................................................................................................11<br />
THIRD NATIONAL HEALTH CARE COMPLAINTS CONFERENCE............................................12<br />
OVERVIEW OF COMPLAINTS ........................................................................................13<br />
FORMAL INVESTIGATIONS ...........................................................................................13<br />
INVESTIGATION INTO REPRESSED MEMORY TREATMENT .........................................................................13<br />
MONASH MEDICAL CENTRE – INFECTION CONTROL ..................................................................................15<br />
PUBLIC INTEREST ISSUES............................................................................................19<br />
MEDICAL RECORDS....................................................................................................................................19<br />
STATUS OF COMPLAINTS LIAISON OFFICERS...............................................................................20<br />
UNREGISTERED PROVIDERS..................................................................................................................21<br />
RURAL ISSUES ..............................................................................................................................................22<br />
ANALYSIS OF COMPLAINT TRENDS .............................................................................22<br />
<strong>2000</strong>/<strong>2001</strong> SUMMARY..................................................................................................................................22<br />
ENQUIRIES ......................................................................................................................................................23<br />
SERIOUSNESS................................................................................................................................................24<br />
COMPLAINTS.................................................................................................................................................25<br />
HOW COMPLAINTS ARE MANAGED .............................................................................26<br />
RESOLUTION BY ENQUIRY OFFICERS...............................................................................................27<br />
RESOLUTION BY INVESTIGATORS......................................................................................................28<br />
CONCILIATION REPORT ...........................................................................................................................30<br />
REGISTRAR’S REPORT...............................................................................................................................31<br />
ABORIGINAL LIAISON OFFICER’S REPORT .....................................................................................32<br />
PRISONER COMPLAINTS ..........................................................................................................................33<br />
OUTCOMES ...................................................................................................................34<br />
REASONS FOR COMPLAINTS .......................................................................................35<br />
CATEGORIES OF COMPLAINTS AGAINST HEALTH SERVICE PROVIDERS .................41<br />
MEDICAL PRACTITIONERS.....................................................................................................................41<br />
GENERAL PRACTITIONERS.....................................................................................................................42<br />
DENTISTS ........................................................................................................................................................43<br />
DENTAL TECHNICIANS.............................................................................................................................44<br />
HOSPITALS .....................................................................................................................................................44<br />
PSYCHIATRIC SERVICES..........................................................................................................................48<br />
HOSPITALS’ COMPLAINT DATA....................................................................................50<br />
OFFICE MANAGEMENT .................................................................................................54<br />
APENDICES ...................................................................................................................59<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 1
STAFF OF THE HEALTH SERVICES COMMISSION AT 30 JUNE <strong>2001</strong><br />
Office Manager<br />
Conciliators<br />
Investigators<br />
Registrar<br />
Inquiry Officers<br />
Aboriginal Liaison Officer<br />
Systems Administrator<br />
Executive Assistant<br />
Receptionist<br />
Michael McDonald has responsibility for the resource<br />
management functions of the office.<br />
Keith Jackson, Teresa Punshon and Kath Kelsey assist<br />
parties to a complaint to a resolution in a confidential<br />
and privileged setting<br />
Orysia Ckuj, Pamela Gilbert and Lynn Griffin assess<br />
complaints, which have not been resolved in the initial<br />
stages, to determine what is required to bring about a<br />
resolution.<br />
Shiranee Sinnathamby is responsible for the case<br />
management of all complaints and inquiries and<br />
supervises the work of the inquiry officers.<br />
Heather Andrew, Jill Aitken and Piotr Nyczek are<br />
responsible for the handling of complaints and inquiries<br />
and provide advice to health service users and providers<br />
during the initial stages of the complaints resolution<br />
process.<br />
Melanie Fraser is responsible for supervising and<br />
monitoring complaints concerning indigenous<br />
Australians and conducting outreach work. She also acts<br />
as an Inquiry Officer.<br />
Philip Punshon is responsible for managing the office<br />
computer network and providing strategic information<br />
technology advice.<br />
Kay MacAlister and Suzie Aron provided executive,<br />
administrative and keyboard support to the<br />
<strong>Commissioner</strong> and carries a small caseload.<br />
Kate Kennedy, Julie-Anne Balash, and Sandra Popovski<br />
(Mental <strong>Health</strong> Review Board) provided receptionist<br />
duties for the office in the <strong>2000</strong>/<strong>2001</strong> financial year.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 2
COMMISSIONER’S SUMMARY<br />
This has been a year of progress and consolidation within the office of the <strong>Health</strong><br />
<strong>Services</strong> <strong>Commissioner</strong> (HSC). Some important restructuring has taken place<br />
internally to ensure the requirements of our legislation are met as effectively as<br />
possible in the public interest. Much of the work undertaken during the latter half of<br />
the year under review will bear fruit in the next financial year. This has included<br />
staff restructuring.<br />
Complaints handling is confidential and most are resolved in the early stages through<br />
mediation. Beginning in the next financial year more cases will go into conciliation<br />
much earlier in the process in the hope they can be resolved quickly in a confidential<br />
and privileged setting. This has meant responses to complaints are required sooner<br />
from health service providers than was previously the case. I take this opportunity to<br />
thank all providers, especially hospital management and staff, who have cooperated<br />
with us. Complaints that deal with issues of professional standards or allegations of<br />
misconduct are referred to the twelve disciplinary boards including the Medical<br />
Practitioners Board, the Dental Practitioners Board and the Nurses Board.<br />
Discussions with these Boards have been constructive and helpful at a policy level as<br />
well as during complaints handling.<br />
Once again I thank all the consumers and advocacy services and the health service<br />
providers who have assisted my officers and I to resolve disputes by providing expert<br />
opinions and referring people to the HSC. We have received assistance from the<br />
medical, dental and other health professions who have assisted us willingly and ably.<br />
We could not have the success rate we currently do without this important assistance.<br />
<strong>Health</strong> Records Act <strong>2001</strong><br />
The <strong>Health</strong> Records Act <strong>2001</strong>, passed in April <strong>2001</strong>, has conferred significant new<br />
responsibilities on the office of the HSC and I am delighted that Victoria’s<br />
Government has had the confidence to entrust us with this important work. The<br />
legislation recognises the extreme sensitivity of health information, establishes<br />
privacy principles and gives patients a legal right of access to information about them<br />
in medical records. The <strong>Health</strong> Records Bill <strong>2001</strong>, as it then was, received the<br />
support of the Opposition and this bipartisan approach will be important in its<br />
implementation. Concerted efforts have begun in consulting with all relevant<br />
stakeholders to provide training, develop guidelines and ensure the legislative<br />
requirements are widely appreciated. The emphasis will be on assisting health service<br />
providers to comply with the requirements, advising consumers of their rights and<br />
conciliating complaints.<br />
Complaints Liaison Officers<br />
The HSC exists to provide an accessible and independent mechanism to receive and<br />
resolve health complaints with a view to improving the quality of health services. I<br />
continue to have a strong interest in quality assurance processes and encourage all<br />
providers to include the complaints liaison officers (CLOs) on their quality assurance<br />
committees to ensure complaints information is used constructively. I do, however,<br />
have some real concerns about the status of the CLOs in some hospitals. Research by<br />
Kay Currie (see page 20 of this report) has indicated they are bearing high work loads<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 3
and are not always receiving the support they need from management. The importance<br />
of including consumer representation on boards and committees is being increasingly<br />
acknowledged in hospitals and other health service provider organisations.<br />
Policy Role<br />
Efforts have continued during the year under review to make HSC more accessible to<br />
Aboriginal Australians and people from non-English speaking backgrounds.<br />
Outreach visits and exchange of information continues, however many patients still<br />
do not have access to trained interpreters and inappropriate use of family members<br />
occurs. Information about HSC and the <strong>Health</strong> Records Act <strong>2001</strong> will be provided in<br />
plain language and in translations. HSC has also been consulting with consumer<br />
groups and Government to contribute to policy initiatives. Close cooperation<br />
continues with important peak bodies like the <strong>Health</strong> Issues Centre Inc., which has<br />
initiated consultations and research into, among other things, mental health policy,<br />
consumer information and privacy. The HSC has also been a member of several<br />
Ministerial Advisory Committees.<br />
During the year under review Michael Gorton as President of the <strong>Health</strong> <strong>Services</strong><br />
Review Council (HSRC) has assisted my office with expertise, encouragement and<br />
advice. Council members have considerable expertise and I use this at every<br />
opportunity. I thank them for their assistance. They also provide an important line of<br />
accountability by reporting directly to the Minister for <strong>Health</strong>.<br />
The relationship between the HSC and the Department of Human <strong>Services</strong> remains a<br />
partnership that respects the independence of the <strong>Commissioner</strong> and I am grateful for<br />
the expertise and advice of Department personnel. My staff and I have benefited,<br />
once again, from internal training seminars at which invited guests have presented<br />
information that has answered our many questions in an informal setting. The<br />
<strong>Commissioner</strong> thanks the following people and organisations:<br />
Dr Mark O’Brien, Holy Spirit Hospital<br />
Sitesh Bhojani & Tom Fahy, Australian Competition and Consumer Commission<br />
Kirsten James, Consultant, Complementary Therapies<br />
Roberta Honigman, Social Worker and Consultant<br />
Roger Crowe, Ombudsman’s Office, Victoria<br />
Greg Lyons, Victorian Administrative and Claims Tribunal (VCAT)<br />
John Snowden, Philips Fox<br />
Kathy Liddell & Dianne Scott, DHS, <strong>Health</strong> Records Act <strong>2001</strong>.<br />
No organisation can function without the cooperation, loyalty and hard work of the<br />
staff. I take the opportunity to thank the staff of the HSC who have continued to carry<br />
out their work in an exemplary fashion.<br />
Tribute to Liz Gallois<br />
Liz Gallois commenced work with the HSC on 30 September 1991 until her<br />
retirement on 28 February <strong>2001</strong>. I thank Liz for her significant contribution to the<br />
Commission in complaints handling and policy work. Liz had a particular interest in<br />
women’s health and in breast screening programs. In her retirement she has (among<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 4
other things) pursued her considerable abilities in creative writing and, I and her<br />
colleagues, thank her and wish her well in her future endeavours.<br />
Beth Wilson<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong><br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 5
HEALTH SERVICES REVIEW COUNCIL<br />
PRESIDENT’S REPORT <strong>2000</strong>/<strong>2001</strong><br />
I am pleased to report that the past year has been another active one for the Council.<br />
The Council, working closely with the <strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong>, provides<br />
advice and support in relation to the issues dealt with by the <strong>Commissioner</strong> under the<br />
<strong>Health</strong> <strong>Services</strong> (Conciliation and Review) Act 1987.<br />
In particular, the Act requires the Council:<br />
• To advise the Minister on the health complaints’ system and the operations<br />
of the <strong>Commissioner</strong>.<br />
• To advise the Minister and the <strong>Commissioner</strong> on issues referred to it by the<br />
<strong>Commissioner</strong>.<br />
• With the Minister’s approval, to refer matters relating to health services’<br />
complaints to the <strong>Commissioner</strong> for inquiry.<br />
Membership<br />
As at 30 June, <strong>2001</strong>, the Council comprised:<br />
Mr Michael Gorton (President)<br />
Dr Paul Nisselle<br />
Mr Neil Wighton Naismith<br />
Ms Pamela Barrand<br />
Ms Dimity Fifer<br />
Mr Anthony Seyfort<br />
Ms July Rolfe<br />
Dr Helen Rabbette<br />
The composition of the Council ensures a broad representation of the interests and<br />
experience of providers in the health system, users of the health system and other<br />
members who bring an independent view.<br />
We note the resignation during the year of Ms Anita Tang, who provided a valuable<br />
contribution to the work of the Council over her short period of tenure.<br />
Unfortunately, due to a move interstate, Ms Tang was unable to remain on the<br />
Council, and we offer our best wishes to her for the future.<br />
We have recently welcomed Ms Marcia Coleman as a new Member.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 6
Review of the Act<br />
During the year, the Minister released a Discussion Paper in relation to the reform of<br />
the Act, importantly including:-<br />
• increased functions and powers for the <strong>Commissioner</strong>;<br />
• amendment to the role and functions of the Council;<br />
• administrative changes to the processes under the Act;<br />
• proposals and options for addressing complaints concerning unregistered<br />
providers of health services, which are not otherwise currently dealt with<br />
under the Act.<br />
The Council was represented on the Working Party which assisted in the development<br />
of the Discussion Paper. The Council assisted in the promotion and dissemination of<br />
the Discussion Paper to ensure proper consultation throughout the community in<br />
relation to the issues raised.<br />
The Council undertook much work in preparing its own submission in relation to the<br />
Discussion Paper, and we are pleased that the Council has had an opportunity to<br />
discuss its submissions with representatives of the Department of Human <strong>Services</strong>.<br />
At the time of this <strong>Report</strong>, we note that proposed reform legislation is being<br />
developed. We are pleased that the Council has been consulted in relation to the<br />
development of the amending legislation and are confident that the <strong>Health</strong> <strong>Services</strong><br />
(Conciliation and Review) Act 1987 will be strengthened and improved as a result.<br />
Working with the <strong>Commissioner</strong><br />
The Council enjoys a strong working relationship with the <strong>Commissioner</strong> and her<br />
staff. Over the past year, the <strong>Commissioner</strong> has again played an important role in<br />
informing the community, consulting with the medical profession, and otherwise<br />
promoting the work of her office. We believe that, as a result, the office of the<br />
<strong>Commissioner</strong> is valued highly by the community, and is generally recognised as<br />
ensuring a fair and transparent process for the handling of complaints within our<br />
health system.<br />
In particular, we note the strong work of the <strong>Commissioner</strong> in recent times dealing<br />
with difficult issues raised from complaints about cosmetic surgery. We note the<br />
active role taken by the <strong>Commissioner</strong> in promoting the need for greater<br />
communication between health providers and consumers. A significant number of the<br />
complaints received by the <strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> relate to poor<br />
communication between provider and patient.<br />
Importantly, during the year, the <strong>Commissioner</strong>, with the assistance of the Council,<br />
conducted a major conference in Melbourne. The Third National <strong>Health</strong> Care<br />
Complaints Conference “Getting Better Together - Using Complaints to Improve the<br />
Quality of our <strong>Health</strong> <strong>Services</strong>” was an important and successful event, with a large<br />
number of significant papers and presentations. It was a worthwhile contribution to<br />
the ongoing debate and development of complaint handling systems within the health<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 7
sector. The Conference culminated in a “hypothetical”, which provided an all too real<br />
response from a broad range of participants for the fictitious scenario considered. The<br />
<strong>Commissioner</strong> and her staff should be congratulated for conducting such an important<br />
conference.<br />
<strong>Health</strong> Records Act <strong>2001</strong><br />
The Council has also been involved in consultations with the <strong>Commissioner</strong> in<br />
relation to the implementation of the <strong>Health</strong> Records Act <strong>2001</strong>.<br />
This important piece of legislation provides a new scheme to deal with issues of<br />
privacy and confidentiality of health records, access by patients and others, as well as<br />
the role of the relationship between doctors and patients.<br />
The new legislation also, importantly, restructures the Council by the addition of two<br />
new members to specifically represent the issues involved with this legislation.<br />
Although the new legislation will not be fully implemented until early next year,<br />
much work has already been undertaken by the <strong>Commissioner</strong>’s office, and much<br />
consideration has already been commenced by the Council in relation to the<br />
requirements of the legislation. The Council has been fully briefed on the<br />
implementation program by the <strong>Commissioner</strong>.<br />
Training and Prevention<br />
The Council has also spent time in recent months developing a proposal to support the<br />
training and education functions of the <strong>Commissioner</strong>. The Council views prevention<br />
as being preferable to cure. It is developing proposals to create and adapt kits and<br />
materials for hospitals and healthcare providers to enable them to more properly deal<br />
with healthcare complaints at source, thereby obviating the cost, delay and effort<br />
required in dealing with formal complaints once they arise. Council’s experience<br />
clearly indicates that, if complaints are dealt with at source, they are more readily<br />
resolved, more likely to address the concerns of all parties involved, and substantially<br />
reduce the costs to the institution or health provider associated with the complaint.<br />
Specific Issues<br />
The Council is also involved, on an ad hoc basis, in advising the <strong>Commissioner</strong> on a<br />
number of particular issues that arise. The Council, and individual Members of the<br />
Council, have been able to provide support and assistance to the <strong>Commissioner</strong> in<br />
relation to specific complaints and investigations conducted by the <strong>Commissioner</strong>’s<br />
office. The Council assists in the development of submissions made by the<br />
<strong>Commissioner</strong>’s office, and receives much material from the <strong>Commissioner</strong>’s office<br />
in relation to current developments, legal issues and progress of work.<br />
Thanks<br />
Finally, we recognise that the work of the Council could not proceed without the<br />
support of a number of people.<br />
First, we again recognise the tireless work of Beth Wilson, the <strong>Health</strong> <strong>Services</strong><br />
<strong>Commissioner</strong>. Her consultative approach to her role is well recognised in the<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 8
healthcare industry. Her office provides support to healthcare providers, as well as<br />
assisting in advocating for users, particularly those less able to advocate for<br />
themselves.<br />
We are grateful for the work of the <strong>Commissioner</strong>’s staff, who are available at all<br />
times to assist the Council in its work.<br />
We are particularly grateful for the support of the Minister and the Department, who<br />
have provided strong support for Council initiatives over the past twelve months, and<br />
consulted with the Council on each of the major developments that have occurred<br />
during that time.<br />
Finally, I thank my fellow Council Members for their time and effort on so many<br />
tasks. We look forward to an active twelve months ahead.<br />
Michael Gorton<br />
President<br />
<strong>Health</strong> <strong>Services</strong> Review Council<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 9
STATUTORY FUNCTIONS<br />
THE ROLE OF THE COMMISSIONER<br />
The Office of the <strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> (HSC) was established in Victoria in<br />
1988. The <strong>Commissioner</strong>’s role is to receive, investigate and resolve complaints from<br />
users of health services, to support health care services in providing quality health<br />
care and to assist them in resolving complaints. The legislation also requires that<br />
information gained from complaints should be used to improve the standards of health<br />
care and prevent breaches of these standards.<br />
The <strong>Health</strong> <strong>Services</strong> (Conciliation & Review) Act 1987 (the Primary Act) states that<br />
the <strong>Commissioner</strong> is to:<br />
a) deal with users’ complaints; and<br />
b) suggest ways in which the guiding principles may be carried out and help<br />
service providers to improve the quality of health care.<br />
The purposes of the Act include:<br />
a) to provide an independent and accessible review mechanism for users of<br />
health services; and<br />
b) to provide a means for reviewing and improving the quality of health service<br />
provision.<br />
GUIDING PRINCIPLES<br />
The guiding principles of the Primary Act promote:<br />
a) quality health care given as promptly as circumstances permit; and<br />
b) considerate health care; and<br />
c) respect for privacy and dignity of persons being given health care; and<br />
d) the provision of adequate information on services provided or treatment<br />
available in terms which are understandable; and<br />
e) participation in decision making affecting individual health care; and<br />
f) an environment of informed choice in accepting or refusing treatment or<br />
participation in education or research programs; and<br />
g) reasonable access to information in records relating to personal use of the<br />
health care system except information which is expressly prohibited by law<br />
from being disclosed or information contained in personal notes by a person<br />
giving health care; and<br />
h) the confidentiality of personal health records.<br />
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EXPECTATIONS AND STANDARDS<br />
The guiding principles establish the range of responsibilities for health services and<br />
the basis upon which a person might complain that a breach of these responsibilities<br />
has occurred. They establish a framework for the HSC to become involved in<br />
improving health services and to report on the problems identified and improvements<br />
made.<br />
OTHER STATUTORY ROLES<br />
The HSC provides training to a wide range of health service users and providers. This<br />
is in accordance with our functions as outlined in section 9 of the Primary Act. A<br />
supportive working relationship exists between the HSC and the complaints liaison<br />
officers at public hospitals and many other health services in Victoria. Dialogue<br />
continues between the HSC, consumer representatives including the <strong>Health</strong> Issues<br />
Centre Inc. and health service providers and their associations.<br />
In April <strong>2001</strong> the Government passed the <strong>Health</strong> Records Act <strong>2001</strong> (the HRA) which<br />
is a health specific piece of legislation designed to protect the privacy of health<br />
records and to give users of health services a right of access to health information<br />
about them. The HRA does not override existing legislation and the Freedom of<br />
Information Act 1982 (FOI) continues to apply to the public sector. The FOI<br />
legislation has been amended to ensure consistency with the HRA. The HSC will<br />
place a strong emphasis on working closely with all stakeholders to ensure the HRA is<br />
well understood.<br />
LIAISON, TRAINING & PROMOTION<br />
The HSC consults regularly with registration boards about complaint handling in<br />
accordance with section 19(6) of the Act. Regular meetings between the HSC and the<br />
Boards are held to determine the most effective and efficient ways of handling<br />
complaints about registered practitioners. This process avoids double handling and<br />
ensures the legislative requirements are met. The <strong>Commissioner</strong> also discusses<br />
relevant issues with the Ombudsman, the Mental <strong>Health</strong> Review Board, the<br />
Intellectual Disability Review Panel, the Office of the Public Advocate, the Coroner,<br />
the <strong>Commissioner</strong> for Equal Opportunity and other relevant authorities. These links<br />
assist our work, especially where the management of complaints involves more than<br />
one office.<br />
The <strong>Commissioner</strong> places strong emphasis on promotion and training to improve<br />
accessibility of the HSC to the public and health service providers. During the year<br />
under review the HSC has been represented at many conferences and venues to<br />
promote the work of the Office. The <strong>Commissioner</strong> gave addresses, lectures and<br />
training at over 100 venues. Also other staff of the HSC delivered lectures and<br />
conducted workshops. Consumers of health services from the non metropolitan<br />
regions, children and adolescents, Koori and Aboriginal Australians and people from<br />
non English speaking backgrounds have been under represented as complainants and<br />
an outreach program has been introduced to make the service accessible to them. The<br />
employment of a full-time Aboriginal liaison officer has assisted with this. Her report<br />
appears on page 32.<br />
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The HSC is also committed to assisting students by providing placements and<br />
supporting research. During the year under review the following students were<br />
assisted:<br />
Naomi Lillis - candidate for Masters of <strong>Health</strong> Psychology from Swinburne<br />
University of Technology. Co-supervised by member of HSC staff whilst<br />
undertaking qualitative and quantitative research evaluating the HSC complaints<br />
process. This research is expected to be completed in <strong>2001</strong> and results will be<br />
reported in the <strong>2000</strong>/<strong>2001</strong> annual report.<br />
Roberta Honigman - candidate for Graduate Diploma in Conflict Resolution from<br />
LaTrobe University. Research involved a qualitative survey of "lost to follow-up"<br />
clients. That is, people who fail to confirm, an apparently serious complaint, in<br />
writing with the HSC.<br />
Rhian Parker - Ph D candidate from Monash University, women's experiences of<br />
cosmetic and plastic surgery.<br />
Natasha Guyfer - Melbourne University, women and prisons.<br />
Elmira Nurmatova – Chisolm Tafe, Identification of and outreach to non-English<br />
speaking background community groups.<br />
The <strong>Commissioner</strong>, Lynn Griffin, Professor Paul Mullen and Dr Grant Lester have<br />
been granted ethics committee approval for a research project: “The Unusually<br />
Persistent Compliant.”<br />
THIRD NATIONAL HEALTH CARE COMPLAINTS CONFERENCE<br />
On 29-30 March, <strong>2001</strong> the HSC hosted the Third National <strong>Health</strong> Care Complaints<br />
Conference, “Getting Better Together: Using Complaints to Improve the Quality of<br />
Our <strong>Health</strong> <strong>Services</strong>”. Over 240 delegates registered for the Conference, which was<br />
held at the Victoria University and opened by the Minister for <strong>Health</strong>, The<br />
Honourable John Thwaites MP.<br />
Those in attendance heard keynote addresses from Professor Paul Mullen, Emeritus<br />
Professor Margaret Bennett AM, Dr Mark O’Brien and Dr Rowan Story. They<br />
participated in a number of sessions on complaint handling and listened to the highly<br />
entertaining and thought provoking hypothetical “The Black Stump Hospital scandal:<br />
Infection control, whistle blowers and the role of the media,” facilitated by Professor<br />
Graham Brown of Royal Melbourne Hospital.<br />
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OVERVIEW OF COMPLAINTS<br />
Throughout this <strong>Annual</strong> <strong>Report</strong> anecdotal information has been used to illustrate the<br />
types of complaint received. Details have been altered to protect confidentiality<br />
and, wherever possible, actions taken or resolutions achieved have been indicated.<br />
Outcomes cannot be indicated where the matter is still in progress and the HSC does<br />
not make judgements or decisions about who is right or wrong. Instead HSC helps<br />
parties to resolve complaints themselves through mediation.<br />
FORMAL INVESTIGATIONS<br />
Last year HSC conducted two formal inquiries.<br />
Investigation Into Repressed Memory Treatment<br />
In March 1999 the HSC was contacted by Ms A, a resident of the United Kingdom.<br />
She was in Australia because of concerns about the well-being of her sister, Ms B (a<br />
trained nurse in her late thirties), who was residing in a Victorian country town (the<br />
Town). According to Ms A, her sister was a patient of a medical clinic (the Clinic)<br />
where she was being treated for amongst other things, depression. She was also<br />
receiving psychotherapy from a psychologist, Mr J. Ms A reported she was shocked<br />
at what she found when she visited her sister. Ms A said her sister appeared to be in a<br />
state of exhaustion. Issues raised by Ms A included possible financial and sexual<br />
exploitation of her sister. She questioned too, the medication which had made her<br />
sister very difficult to communicate with and counselling sessions which lasted for<br />
hours. She mentioned a “blackmailing” letter demanding money that had been sent to<br />
her father by a psychologist, Mr J.<br />
Ms A was told that as HSC had no complaint from Ms B the Office could not<br />
intervene. She was told she could call the Crisis Assessment and Treatment Team<br />
(CAT Team) if she had concerns for her sister’s mental health and she was advised of<br />
the roles of the Medical Practitioners Board of Victoria (MPBV) and the Phycologists<br />
Registration Board (PRB).<br />
Under section 19(6) of the <strong>Health</strong> <strong>Services</strong> (Conciliation and Review) Act 1987 (the<br />
Act): “If a complaint relates to a registered provider the <strong>Commissioner</strong> must refer the<br />
complaint to the appropriate registration board if after consultation with the provider’s<br />
registration board the <strong>Commissioner</strong> considers that the board has power to resolve or<br />
deal with the matter is not suitable for conciliation under the Act”.<br />
After consulting with the MPBV and with the PRB and after taking advice form the<br />
<strong>Health</strong> <strong>Services</strong> Review Council the HSC decided to request the Minister for <strong>Health</strong><br />
to make a reference to HSC under section 9(m) of the Act asking the <strong>Commissioner</strong> to<br />
conduct a formal investigation of the Clinic.<br />
The Minster was advised that HSC had received a complaint from the sister of a<br />
patient at the Clinic which involved allegations of possible financial and sexual<br />
exploitation. It had been brought to HSC’s notice that the police at the Town also had<br />
some concerns about the practices at the Clinic. While the PRB and the MPBV have<br />
jurisdiction to deal with matters related to registered providers the Clinic also<br />
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employed people who were not registered practitioners.<br />
health provider whether registered or not.<br />
HSC can investigate any<br />
On the 23 November 1999 HSC received the following advice from the Minister for<br />
<strong>Health</strong>:<br />
“…The allegations you have outlined are of a serious nature and it is important<br />
that an investigation of the practices of [the Clinic] is undertaken in order to<br />
assess the accuracy or otherwise of these allegations.<br />
I therefore request that the Office of the <strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> undertake<br />
a formal investigation of [the Clinic] in line with the advice you have received<br />
from the Medical Practitioners Board of Victoria, the Psychologists Registration<br />
Board and the President of the <strong>Health</strong> <strong>Services</strong> Review Council”.<br />
The issues for investigation were:<br />
• Is the health and/or safety of any user of the clinic services at risk?<br />
• Is there any substance to allegations that the clinic is or was engaged in<br />
financial and/or other exploitation?<br />
During the course of the investigation the Clinic closed. After extensive inquiries the<br />
HSC found that because the Clinic had closed the health and/or safety of any user was<br />
not currently at risk. With regard to the second term of reference the HSC found no<br />
evidence of financial exploitation by the Clinic but it noted that the clinical<br />
management of the patient by the general practitioner, Dr C and the psychologist, Mr<br />
J raised a number of concerns. The HSC decided that Dr C had allowed his judgement<br />
to be clouded. He told the HSC he had assisted Mr J in keeping the patient away<br />
from traditional psychiatric services. He said there was an agreement between<br />
himself and Mr J regarding this: “Dr C said he had an agreement with Ms B that they<br />
would do anything to prevent her involuntary admission. However, she had to agree<br />
to certain treatment conditions”.<br />
The Mental <strong>Health</strong> Act 1986 (Vic) governs the provision of care to involuntary<br />
patients with mental illness. It contains strict criteria which must be met before a<br />
person can receive a treatment as an involuntary patient. It also makes provision for<br />
independent review by the Mental <strong>Health</strong> Review Board. Dr C cannot come to<br />
private arrangements to “contract out” of the legislation or to use the purported<br />
agreement to get Ms B “to agree to certain treatment conditions.”<br />
Dr C was also aware of late night counselling sessions Mr J conducted with Ms B. Dr<br />
C visited her at the Hospital during this time and was aware of the medication she was<br />
on and the fact that she was in a state of exhaustion. He nonetheless did nothing to<br />
stop what was happening and appears instead to have encouraged it. His notes on her<br />
Hospital file include: “She states if there is anything more to be dug out I will not be<br />
able to stand for it”. Eventually it was the nursing staff, not Dr C, who called a halt to<br />
the late night removal of the patient by Mr J. The HSC recommended that Dr C’s<br />
management of Ms B be referred to the Medical Practitioners Board of Victoria for<br />
action.<br />
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The HSC had serious concerns about the psychologist, Mr J’s, conduct and considered<br />
he put the health and safety of his patient at risk. As a registered psychologist he had<br />
a duty to uphold the standards of his profession and behave in an ethical way. HSC<br />
decided there was prima facie evidence that Mr J either created the illness in his<br />
patient, Ms B, or contributed to its longevity and seriousness. There is evidence in the<br />
form of the letter to Ms B’s father that he did this for financial gain. The letter<br />
“requesting” payment of $30,000 in fees also contained a threat that legal action<br />
would be taken if the money was not paid. The HSC considers it was inappropriate<br />
for Mr J to seek fees from the patient’s father in this way.<br />
The HSC noted, “The area of repressed memory therapy is fraught with controversy<br />
and Mr J’s treatment regime with the late night visits, the exhausted state of his<br />
patient, the claims of thousands of memories recovered from the age of two years<br />
following therapy sessions lasting for hours could not be described as professional.<br />
Mr J himself told the HSC that the recovery of so many memories was, amazing,<br />
incredible and difficult to believe.”<br />
While Mr J told HSC in the first interview with him he was not currently working as a<br />
psychologist he subsequently changed this and said he was treating some patients.<br />
This led HSC to find him not to be particularly credible.<br />
The HSC recommended that Mr J’s management of Ms B be referred to the<br />
Psychologists Registration Board for action.<br />
HSC was particularly impressed with the evidence of Ms H, the trainee psychologist<br />
at the Clinic. Ms H was on placement at the Clinic where she found herself in a<br />
difficult situation. Although only recently qualified Ms H behaved professionally<br />
throughout and her oral evidence and notes indicate she clearly understood the<br />
importance of setting boundaries and of not being involved in treatment, which she<br />
considered to be unprofessional. She was criticised by Mr J for this but she remained<br />
steadfast to the professional standards of her training.<br />
Monash Medical Centre – Infection control<br />
On the 24 March <strong>2000</strong>, HSC received a letter from the Minister for <strong>Health</strong> requiring<br />
an Inquiry under section 9(1)(m) of the Act. The terms of reference were:<br />
1. Whether the systems in place at Monash Medical Centre (MMC) are adequate<br />
to ensure appropriate monitoring of hospital-acquired infections in the<br />
neonatal special care nursery and cardiac surgical unit; and<br />
2. Whether actions taken to reduce hospital acquired infection rates in these two<br />
units have been adequate and successful and whether any further action is<br />
necessary.<br />
HSC interviewed many experts and noted that:<br />
In late 1999, Bill Birnbauer, The Age, made a FOI request to the Southern <strong>Health</strong> Care<br />
Network (HCN), concerning infection rates in the neonatal special care nursery and<br />
the cardiac surgical unit at MMC. On 27 February <strong>2000</strong> a newspaper article by Bill<br />
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Birnbauer was published in The Sunday Age. The article was about infection rates in<br />
the neonatal special care nursery and the cardiac surgical unit at the MMC and based<br />
on the information supplied under the FOI request.<br />
The HSC received the terms of reference for the Inquiry on 24 March <strong>2000</strong>, under<br />
section 9(1)(m) of the <strong>Health</strong> <strong>Services</strong> (Conciliation and Review) Act 1987.<br />
The DHS, Quality Branch, had taken steps, since October 1999, to improve infection<br />
control in public hospitals, including requiring all public hospitals to provide a plan of<br />
their infection control strategies and protocols. A panel of experts had reviewed the<br />
plans and the Quality Branch, at the time of the Inquiry, was in the process of<br />
providing feedback and/or requiring further detail. The process included the MMC.<br />
In April <strong>2000</strong>, a comprehensive plan to improve infection control in public hospitals<br />
in Victoria was Tabled in Parliament by the Minister for <strong>Health</strong>. The range of<br />
infection control measures included the requirement of all Metropolitan <strong>Health</strong><br />
<strong>Services</strong> and hospitals to develop a Strategic Management Plan for submission to the<br />
DHS.<br />
Discussion<br />
Infection control is a vital part of hospitals and public health services. If underresourced,<br />
or if carelessness and poor attitudes prevail, the health and safety of the<br />
public are put at risk. While there will always be some risk, processes need to be in<br />
place to ensure that these risks are minimised. Infection control has not always been<br />
given the highest, or integrated, priority in our health services as hospitals strive to<br />
meet all demands. Media attention to the issue, for example, Bill Birnbauer’s<br />
reporting in The Age, has been useful in increasing the awareness of hospital<br />
administrators, staff and the public to the importance of allocating adequate resources<br />
and improving infection control practices, monitoring and reporting.<br />
Effective infection control requires changes in attitude, ownership of the problems<br />
and changes in behaviour in all areas of hospitals including – food services, rubbish<br />
collection, theatre procedures and sterilisation techniques, and the use of re-usable or<br />
single use items.<br />
There is a dearth of risk-adjusted and validated data available on infection control and<br />
prevention in Victorian public hospitals. The situation is beginning to change with<br />
the DHS proposal for the establishment of an independent co-ordinating centre to<br />
provide advice and support for the Victorian Nosocomial Infection Surveillance<br />
System (VICNESS). It is envisaged that the Centre will “collect, feedback and<br />
publish aggregated, risk-adjusted, procedure specific infection rates and provide<br />
education and training to participating institutions.<br />
The Southern HCN, its Board, MMC and the Infection Control Advisory Committee<br />
have been proactive in facilitating infection control best practices and in researching<br />
methods of evidence based proactive to contain and control infections.<br />
A considerable amount of work has already been progressed in <strong>2000</strong> by the DHS,<br />
Quality and Continuity Care Branch concerning all Victorian public hospitals. The<br />
MMC, and the Board of Southern HCN, have been eager to identify and address<br />
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infection control issues. The Southern HCN Board has identified, in its Infection<br />
Control Strategic Management Plan <strong>2000</strong>-2003, the need for additional financial<br />
resources in order to implement the Plan.<br />
There are comparative, risk adjusted, data on deep sternal wound infection rates<br />
available from five cardiac surgical units, including MMC, as collected and analysed<br />
by the Victorian Infection Control Surveillance Project (VICSP). The most recent<br />
data are for the period August 1998 to May <strong>2000</strong>. The statistics for MMC are almost<br />
identical to the aggregate for the five hospitals. There is no significant difference<br />
between the five hospitals.<br />
MMC provided data on cardiac surgery surgical site infections for the period February<br />
1999 to September <strong>2000</strong>. These show the number of people having cardiac surgery<br />
by month, the number of infected patients and those who developed deep sternal<br />
wound infections. The data are not risk adjusted. Deep sternal wound infections<br />
appear to be an uncommon event, with 13 cases from almost 600 surgical procedures<br />
(or 2.2%), between February 1999 and September <strong>2000</strong>.<br />
Data are collected on in-patients only. Because only in-patient data are collected the<br />
possibility exists, therefore, that discharged cardiac surgical patients may have a<br />
nosocomial infection but not be counted in the statistics. This may lead to undetected<br />
rates of nosocomial infections (excluding deep sternal wound infections) as lengths of<br />
stay decrease. Hospitals performing cardiac surgery, including MMC, should<br />
consider measuring nosocomial infection rates following discharge. Ultimately this is<br />
a resource issue which needs to be addressed.<br />
MMC provided data on levels and groupings of staff, from senior clinicians to ward<br />
cleaners, who had attended in-service/orientation on infection control. The<br />
information provided indicated that nursing staff regularly attended infection control<br />
training and up-dates. However, medical staff were not proportionally represented in<br />
the data. It appears that more needs to be done to ensure that medical staff are<br />
educated in infection control and prevention.<br />
Findings<br />
In response to the first term of reference –<br />
1. Whether the systems in place at Monash Medical Centre (MMC) are adequate<br />
to ensure appropriate monitoring of hospital-acquired infections in the<br />
neonatal special care nursery and cardiac surgical unit;<br />
The monitoring of nosocomial infections is clearly recognised by health care<br />
professionals to be an ongoing challenge. It has been identified as a current priority<br />
area and is receiving extra resources from the DHS. These initiatives are supported<br />
by Government policy, receive DHS support and leadership in the arena of infection<br />
control and prevention. MMC has submitted an infection control plan, to the DHS,<br />
which has resource implications.<br />
The DHS has recently completed a review of all public hospital infection control<br />
Plans and will advise MMC, and all other public hospitals, of their suitability and<br />
acceptability.<br />
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The MMC Cardiac Surgical Unit and New Born <strong>Services</strong> have identified, through<br />
regular meetings and audits, infection control and prevention and important changes<br />
have been implemented.<br />
The MMC has identified, in its recent Infection Control Strategic Management Plan<br />
<strong>2000</strong>-2003, that the systems in place are not “adequate to ensure appropriate<br />
monitoring of hospital-acquired infections”. Further “There is obviously a need, as<br />
recognised by an external review, for an effective coordinated Southern <strong>Health</strong><br />
infection control service that meets the needs of all sites and programs.” The<br />
Southern HCN is seeking resources considered necessary to implement (world) best<br />
practice in respect of infection control and prevention. HSC considers that infection<br />
control is a core function within all hospitals.<br />
In response to the second term of reference –<br />
2. Whether actions taken to reduce hospital acquired infection rates in these two<br />
units have been adequate and successful and whether any further action is<br />
necessary.<br />
The definition of “successful” is taken to be a reduction in the number of infections<br />
detected, or the proportion of people who become infected.<br />
As a generalisation, further action will always be necessary and constant vigilance<br />
required to address and support infection control and prevention issues.<br />
The review of infection control services of the Southern HCN, commissioned by the<br />
Board and authored by Professor Wesselingh and Ms Harrington, provides expert<br />
opinion on the optimal structure for the delivery of an effective infection control<br />
service for the Network. The recommendations are reflected in the Network’s<br />
Infection Control Strategic Management Plan <strong>2000</strong>-2003, August <strong>2000</strong>.<br />
Recommendations<br />
The HSC endorses and supports the measures of the DHS in implementing<br />
Government policy on infection control and prevention utilising best practice. These<br />
proposed changes and improvements (towards best practice) have resource<br />
implications which are being addressed by the DHS and Government. Provision of<br />
risk adjusted, validated data to allow for comparison between hospitals is of<br />
paramount importance.<br />
Recommendations that could be made for improvement of the cardiac surgical unit<br />
and newborn services are already addressed in the DHS documents and Southern<br />
HCN Strategic Management Plan <strong>2000</strong>-2003.<br />
The standardised (Statewide) system of definitions, collection, monitoring and<br />
reporting on hospital acquired infections Victoria wide – reportable to<br />
VICSP/VICNISS or similar – for cardiac surgery, neonates and other procedures, of<br />
all nosocomial infections is currently being pursued.<br />
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The Victorian Advisory Committee on Infection Control (VACIC) should continue to<br />
address the issue of infection control orientation and on-going training of medical,<br />
nursing and other staff groups within the public hospital system. This process could<br />
include standardisation of course content, duration and quality processes which ensure<br />
active involvement of all staff, particularly medical staff.<br />
Consumers have a right to expect the achievement of world’s best practice in infection<br />
control and prevention and the right to know if it is not being achieved, and the<br />
reasons why. Publication of infection control risk adjusted data, for all procedures, is<br />
recommended following a reasonable pilot period of adjustment.<br />
PUBLIC INTEREST ISSUES<br />
Complaints can indicate trends within the health care system that have implications<br />
for the general public. Public interest is defined by the following criteria:<br />
1. The circumstances outlined in the complaint are likely to affect a significant<br />
number of people.<br />
2. These circumstances impact on certain population groups.<br />
3. The complaint is indicative of a systematic flaw, the result of a deficiency in<br />
policy or procedures.<br />
4. The complaint raises an issue that is individual in nature but that occurs<br />
unreasonably often, suggesting that a systemic problem exists.<br />
These criteria have been used to highlight complaints as they move through the<br />
system so the public interest issue may be given appropriate attention in conjunction<br />
with the individual’s complaint. A review of complaints so labelled has highlighted a<br />
number of issues.<br />
MEDICAL RECORDS<br />
Most of the complaints received by the HSC contain failures of communication. The<br />
<strong>Commissioner</strong> has concerns about the poor state of record keeping by many health<br />
practitioners. The courts in Australia have made it clear in cases like Kite v Malycha<br />
SASC 6702, 10 June 1998 that poor record keeping could be the basis of a medical<br />
negligence claim. Frequently the writing is difficult to understand which has the<br />
potential to cause further mistakes and to damage patients. Sometimes there are<br />
serious omissions in medical records with doctors saying they are too busy to<br />
complete the record. This places doctors at risk of medical negligence claims and the<br />
patients may be harmed because valuable information is not available. Medical<br />
practitioners need to take into account the fact that the <strong>Health</strong> Records Act <strong>2001</strong>,<br />
which will begin operation in March 2002, will grant patients a legal right of access to<br />
information in records about them. The legislation also obliges organisations that<br />
handle health information to do so in accordance with eleven privacy principles which<br />
appear in the schedule to the Act. Good record keeping is part of good health care.<br />
Some providers who counsel families adopt the risky practice of keeping one set of<br />
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notes. This is problematic where the family subsequently separates and one side may<br />
subpoena the records for a court hearing.<br />
STATUS OF COMPLAINTS LIAISON OFFICERS<br />
In Victoria, there are over 150 complaints liaison officers (CLOs) who work in the<br />
public and private hospitals and other larger medical practices. It is the responsibility<br />
of these officers to deal with complaints at the local level so they might be resolved<br />
quickly. These people receive support and training from the HSC and many have<br />
attended for orientation days. Information technology support is also provided. Their<br />
work is difficult and very important.<br />
In the year under review a thesis for the degree of Masters of Public <strong>Health</strong>, Monash<br />
University was completed by Kay Currie. This indicated that the status of CLOs in<br />
some of our hospitals is poor. The best CLOs are those who receive good support<br />
from management of their facilities. It is the experience of the HSC that the best<br />
hospitals also have well trained and supported CLOs. Kay Currie’s research is<br />
summarised below.<br />
Mechanisms to resolve point of service complaints in acute public hospitals are<br />
variable between as well as within organisations. Complaint processes are not<br />
specified in legislation or by accompanying regulation; consequently, what<br />
mechanisms there are, tend to reflect the underlying culture and philosophy of the<br />
organisation. There may be a centralised system closely allied to quality or risk<br />
management activities or alternatively, complaint handling may be disseminated<br />
throughout the organisation, with prime responsibility resting with individual<br />
supervisors and unit managers. The <strong>Health</strong> <strong>Services</strong> (Conciliation & Review) Act<br />
1987 does state that where reasonable and appropriate, complaints should be resolved<br />
directly with the service provider in the first instance. Additionally, the Act suggests<br />
that complaints management should be associated with quality assurance (section 10f)<br />
but is unclear on how this is to be achieved.<br />
The aims of this study were to:<br />
• Look at the different models of complaint management in acute care<br />
metropolitan and regional public hospitals in Victoria.<br />
• Profile CLO’s in terms of their background, training and structural position<br />
within their organisations, and<br />
• Determine the relationship between models of complaint management in acute<br />
care metropolitan and regional public hospitals in Victoria and the number of<br />
complaints received by that hospital.<br />
There is only limited general research on the staff that handle complaints in acute<br />
health care settings and little is known about their qualifications, skills or training in<br />
Victoria. There has never been a statewide evaluation of the mechanisms applied in<br />
point of service complaints management in acute public hospitals and therefore little<br />
evidence on which to determine what might constitute a best practice model.<br />
CLOs at metropolitan and regional acute care public hospitals were asked to complete<br />
a survey questionnaire after Chief Executive Officers were informed about the study.<br />
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A focus group of six CLOs was also conducted on a range of issues around the<br />
handling and resolution of complaints.<br />
Complaint Liaison Officer was a designated specialist role in 78% of metropolitan<br />
hospitals but only 10% of regional hospitals had a specialist role. Most were female<br />
(70%) and aged between 40 – 59 (77%). The median length of time in the CLO<br />
position was under 2 years. Complaint staff had little in common on skills,<br />
background, or qualifications, but 86% had a tertiary qualification, not specific to<br />
their role in a diverse range of fields. While 63% of complaint liaison officers had<br />
undertaken some training in complaint management, this was principally related to 1 -<br />
3 days orientation provided on initial appointment. Only 46% of CLOs specified a<br />
particular model of complaint management with most of these (78%) being from<br />
metropolitan hospitals. Specialist CLOs were significantly more likely to be members<br />
of a peak body. Where there was a specialist complaints management role, complaint<br />
issues categories relating to access to care were significantly higher but treatment<br />
issues were lower. There were also significantly more complaints received and<br />
recorded in hospitals with a specialist CLO than those without.<br />
In the focus group discussion CLOs reported often feeling under prepared for the<br />
range of tasks required, inadequate training opportunities and a lack of organisational<br />
and senior management support. Stress and “burn out” were issues of concern and<br />
61% had access to internal debriefing services. Given the sensitivity of the issues<br />
handled and staff involvement it was surprising that access to external debriefing was<br />
the exception. The CLOs indicated the data generated was under-utilized by the<br />
organisation and often devalued as a quality indicator. While there was consensus in<br />
the group on the need for better training, there was little agreement on the priorities or<br />
what was the most appropriate type of training with the exception of counselling<br />
skills.<br />
This study highlighted some of the differences in approach to complaint management<br />
and suggests that many hospitals consider patient complaints a low priority. The<br />
diversity in the qualifications and seniority of CLOs, and in their education, training<br />
and skills, levels of autonomy, and degree of involvement in organisational quality<br />
processes, demonstrated the different models or frameworks used by hospitals to<br />
manage patient complaints. The lack of supporting evidence of the effectiveness of<br />
the different models would suggest that much more research is required. In an era of<br />
evidence-based medicine, it seems reasonable to require practice not to be just based<br />
on available evidence but also to seek to establish such evidence through rigorous<br />
research.<br />
UNREGISTERED PROVIDERS<br />
Last year the HSC was involved in a court case, R v Patterson. This dealt with the<br />
issue of an unregistered provider being charged with sexual offences under s51 of the<br />
Crimes Act 1958. The provider was subsequently acquitted. When the HSC is<br />
dealing with registered practitioners, and matters of sexual misconduct arise, these can<br />
be referred to the relevant medical registration board for formal inquiry and<br />
investigation. There are no boards available to deal with complaints about<br />
unregistered providers. In Victoria it is possible for a person to be deregistered for<br />
professional misconduct but to subsequently practice as a counsellor or even<br />
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psychotherapist. While the HSC has jurisdiction over these practitioners it is often<br />
difficult to resolve complaints because there is no registration board.<br />
RURAL ISSUES<br />
HSC has been contacted by patients from the regional areas of Victoria who<br />
complain that waiting lists are very long in the regions and hospital managers in<br />
Melbourne do not understand their situation nor cater to their needs. As a result<br />
people from places like Mildura prefer to travel to Adelaide where hospitals are<br />
apparently more sympathetic to rural concerns.<br />
A woman required surgery. She paid over $350 in airfares to travel to<br />
Melbourne and her accommodation was booked. When she arrived, she was told<br />
the surgery was cancelled and she should return to the Hospital in a week. There<br />
was no consideration given to the fact that she lived so far away, nor to the<br />
expenses she had incurred.<br />
A patient had multiple polyps in her nose that caused discomfort and was<br />
embarrassing. The condition had disadvantaged her socially and in her search<br />
for work. The waiting list at her local regional hospital was two years. The<br />
woman felt she had no option but to have the operation in a private hospital in<br />
Melbourne that was expensive and inconvenient.<br />
The <strong>Commissioner</strong> is aware that the Minister for <strong>Health</strong> has asked<br />
the Department of Human <strong>Services</strong> and the Advisory Committee<br />
on Elective Surgery to develop a set of protocols to address this<br />
problem. The protocols are expected to be completed early in<br />
the next financial year and HSC considers these should be<br />
implemented as a matter of urgency.<br />
ANALYSIS OF COMPLAINT TRENDS<br />
<strong>2000</strong>/<strong>2001</strong> SUMMARY<br />
Complaints and enquiries are received on the telephone, by mail and in person. Some<br />
of these can be handled immediately and are recorded as enquiries. The total number<br />
of enquiries and cases for <strong>2000</strong>/<strong>2001</strong> is 9786 compared with 9654 in 1999/<strong>2000</strong>.<br />
As is consistent with previous years a timely response and explanation, accompanied,<br />
where appropriate by an apology, is the best way to resolve disputes quickly. On the<br />
other hand delays, secretiveness, a refusal to apologise and unnecessary delays<br />
escalate disputes. The <strong>Commissioner</strong> is grateful to all providers who responded to<br />
complaints and assisted in their resolution. Thanks are also due to consumers who<br />
take the time and effort to lodge a complaint. All parties are encouraged to view<br />
complaints in a positive way so they can lead to quality improvements.<br />
Table 1 below shows the complaints and enquiries received by the <strong>Commissioner</strong><br />
during <strong>2000</strong>/<strong>2001</strong> and the figure gives the number of complaints and enquiries for the<br />
past two years.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 22
Table 1. New Complaints and Enquiries<br />
Complaints<br />
Enquires by<br />
telephone<br />
Single contact Accepted Cases Total<br />
6990 1526 1270 9786<br />
Figure 1. Complaints & Enquiries<br />
00/01<br />
99/00<br />
Complaints & Enquiries<br />
(July - June)<br />
6990 7300<br />
1270 1171 1526 1183<br />
Accepted Cases<br />
Single Contact<br />
Complaints<br />
Phone Enquiries<br />
In <strong>2000</strong>/<strong>2001</strong> the total number of enquiries was 6990 compared with 7300 in the<br />
previous year. This is a decrease of 310 or 4.25% over the previous year. As in<br />
previous years approximately half of the complaints and enquiries received by the<br />
HSC are closed following a single contact. The other half proceed to be accepted<br />
cases.<br />
ENQUIRIES<br />
An enquiry is defined as a contact with the Office that does not develop into a<br />
complaint case. A telephone enquiry can often be resolved immediately. The caller is<br />
given advice or referred appropriately. Potential cases, where the caller makes initial<br />
contact to receive advice or information about a health complaint but makes no further<br />
contact accounted for 1836 of these enquiry calls.<br />
Table 2. Telephone enquiries<br />
Total %<br />
Potential Cases 1836 26%<br />
Assistance & Referrals Given 5154 74%<br />
Total calls 6990 100%<br />
In the period from July <strong>2000</strong> to June <strong>2001</strong> the Office received 6990 telephone<br />
enquiries. Seventy four percent of these callers were assisted or referred to other<br />
agencies. Of these:<br />
• 13% related to fees<br />
• 13% to food and environmental health issues<br />
• 35% were matters outside the HSC jurisdiction in which the caller was referred to<br />
another agency<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 23
• 6% concerned access to records<br />
• 5% were about health insurance issues and the remaining related to public hospital<br />
waiting lists, Aboriginal enquiries and other non-specified matters.<br />
SERIOUSNESS<br />
Although all complaints are serious to the individuals concerned, and all are handled<br />
with diligence, for management purposes complaints are rated on a scale for<br />
seriousness when they are first accepted by the <strong>Commissioner</strong> and again when they<br />
are closed. It is often difficult to assess seriousness at the start of a complaint. This<br />
practice of revising the rating at the time of closure has led to fewer complaints being<br />
rated as serious or substantial and to more being rated lower on the scale.<br />
Seriousness Rating<br />
1. Trivial: frivolous, vexatious, obviously misconceived or where an<br />
investigation is unwarranted.<br />
2. Minor: the problem is easily resolved by a phone call or letter and an<br />
explanation is sufficient<br />
3. Routine: there has been a misunderstanding; issues frequently involve access<br />
to records, disputes about costs, discourtesy, diagnostic or treatment errors<br />
without serious sequel.<br />
4. Substantial: there are significant quality assurance implications, changes in<br />
practice are needed to avoid a recurrence or there is a need for policy<br />
development.<br />
5. Serious: usually associated with personal injury, professional misconduct,<br />
unlawful or unethical acts, lack of informed consent with adverse outcomes<br />
Table 3. Seriousness by Issue at Closure <strong>2000</strong> - <strong>2001</strong><br />
Trivial Minor Routine Substantial Serious Total<br />
Access 52 81 140 30 7 310<br />
Administration 11 21 24 4 1 61<br />
Communication 39 104 202 21 8 374<br />
Cost 28 66 46 1 0 141<br />
Rights 23 59 147 34 21 284<br />
Treatment 176 249 824 394 67 1710<br />
Not spec 71 3 20 3 1 98<br />
Total Closed 400 583 1403 487 105 2978<br />
During the period under review 2978 complaints were closed of which 1403 (47%)<br />
were regarded as routine, 583 (20%) minor, 487 (16%) substantial, 105 (4%) serious<br />
and 400 (13%) trivial. Of the substantial and serious complaints 461 (78%) involved<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 24
treatment issues, 55 (9%) rights issues, 37 (6%) access issues, 29 (5%)<br />
communication issues and 5 (1%) administration issues.<br />
Treatment issues regarded as serious or substantial primarily consisted of negligent<br />
treatment (27%), inadequate treatment (25%), inadequate diagnosis (17%) and<br />
unskilful or incompetent treatment (13%).<br />
Serious Complaint<br />
A man injured his hand while playing sport. He went to a nearby emergency<br />
department of a public hospital where an x-ray was taken and a doctor examined<br />
him. He was told the hand was not broken and he should rest it. A support and<br />
sling were provided. The pain continued over the following week, so the man<br />
visited his usual doctor for advice. On examination the doctor thought the hand<br />
was broken and ordered another x-ray that confirmed the fracture to the base of<br />
the thumb. A review of the first x-ray showed an undisplaced fracture at the site.<br />
The doctor from the Hospital apologised, acknowledged the fracture had been<br />
missed and explained it was hard to see on the x-ray as the hand had been too<br />
swollen to examine properly at the time. The Hospital offered to provide some<br />
physiotherapy to assist the man in recovery and this offer was accepted.<br />
Substantial Complaint<br />
A woman from a non-English speaking background was admitted to a hospital<br />
for the birth of her first child. The labour was long and difficult and the baby<br />
was born unwell and spent considerable time in intensive care. Eventually the<br />
child appeared to be doing well. The woman complained that this could have<br />
been avoided if the Hospital had conducted a caesarean delivery rather than<br />
allowing her to deliver that baby vaginally. The HSC asked an independent<br />
expert to review the woman’s anti-natal and labour records and to comment on<br />
the care provided. The expert advised that the baby had some identified<br />
problems prior to birth and there would have been less risk to the child if a<br />
caesarean section delivery had been performed. The Hospital apologised to the<br />
woman and said that the doctor involved had been counselled and they would<br />
ensure an experienced doctor would be available at all times in the future. The<br />
woman delayed her compensation claim because the child was too young to be<br />
assessed at that time.<br />
COMPLAINTS<br />
In the twelve months under review the Office received 2796 new complaints<br />
comprising 1526 single contact complaints, where the complainant is encouraged to<br />
approach the health service provider to seek a resolution, and 1270 complaints<br />
(accepted cases), which were confirmed in writing. This represents a 7% increase<br />
over the previous year.<br />
WHO COMPLAINED?<br />
A complainant is defined as the person who makes the complaint. This is most often<br />
the patient or user of the health service. In the period under review 67% (1872)<br />
complaints were lodged by the user, 23% (649) complaints by a recognised<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 25
epresentative (where the user is a minor, or has a legal guardian), 8% (215) were<br />
made by a chosen representative of the user and in 2% (56) were unspecified. <strong>Health</strong><br />
service providers lodged four complaints on behalf of patients. Complaints from<br />
providers can only be accepted where the patient nominates the provider to represent<br />
them and the Commission accepts that they have a sufficient interest or where the<br />
patient cannot complain because of, for example, incapability.<br />
Table 4. Consumer Profile<br />
Female Male Not specified Total<br />
Under one 10 14 2 26<br />
1-4 24 29 4 57<br />
5-14 24 30 3 57<br />
15-24 34 33 1 68<br />
25-34 93 48 1 142<br />
35-44 103 41 1 145<br />
45-54 76 39 3 118<br />
55-64 43 36 1 80<br />
65+ 121 77 2 200<br />
Not specified 867 668 368 1903<br />
Grand Total 1395 1015 386 2796<br />
Figure 2. Consumer Profile<br />
Consumer Gender<br />
Not specified<br />
14%<br />
Male<br />
36%<br />
Female<br />
50%<br />
Consistently more complaints are received from women than from men. Women tend<br />
to come into contact with health services more often and they are frequently carers<br />
complaining on behalf of others.<br />
HOW COMPLAINTS ARE MANAGED<br />
The Act requires that complaints made on the telephone or in person be confirmed in<br />
writing. Assistance is offered to people needing it, however many preliminary<br />
complaints are not confirmed in writing. The legislation anticipates that consumers<br />
will attempt to resolve issues themselves wherever possible and staff advise<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 26
complainants, where appropriate, to make direct contact with the service provider. It<br />
is hoped that many of the unconfirmed complaints are resolved in this way.<br />
RESOLUTION BY ENQUIRY OFFICERS<br />
The enquiry telephone line operates from 9am to 5pm, five days a week. At other<br />
times messages may be left on the answering machine. Enquiry officers are usually<br />
the first point of contact for members of the public and have a broad knowledge of<br />
health issues and, where appropriate, provide referrals to other agencies if the enquiry<br />
does not come within the jurisdiction of the HSC.<br />
When enquiries are received by telephone, an enquiry officer listens and assesses the<br />
issue/s the caller is presenting. If the complaint is about a health service provider, and<br />
the complainant is unable to resolve the matter directly, a complaint form is sent out.<br />
The caller is asked to complete the form and give details of the complaint.<br />
Enquiry officers record all potential complaints on the database. If a complaint is not<br />
confirmed in writing, the matter is closed. If a complaint is from a person from a non-<br />
English speaking background the enquiry officer may access interpreter services and<br />
assist the complainant in lodging the complaint. Enquiry officers also interview<br />
prospective complainants when they present in person.<br />
Confirmed complaints are entered on the database in detail, including a summary of<br />
the complaint. A hard file is made up and an acknowledgment letter sent to the<br />
complainant. An accepted complaint is sent to the health service provider who is<br />
asked to respond within 28 days. A response may be in writing directly to the<br />
complainant or sent via the HSC depending upon the circumstances. The majority of<br />
accepted complaints are resolved at this stage. A provider may prefer to arrange a<br />
meeting with the complainant in an endeavour to resolve the matter.<br />
If the complainant remains dissatisfied, HSC requires a response from the user<br />
outlining the unresolved issues. If the complaint requires further assessment or is<br />
close to resolution an extension of time by another 28 days may be granted.<br />
Enquiry Officers carry a caseload of approximately 75 cases each.<br />
Table 5 below shows the broad resolution categories for these complaints.<br />
Table 5. Resolution by Enquiry Officers<br />
Outcome 1999/00 <strong>2000</strong>/01<br />
Declined 26% 17%<br />
Referred elsewhere 5% 2%<br />
Withdrawn by user 6% 6%<br />
Investigation unwarranted 0% 1%<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 27
Unsubstantiated 0% 0%<br />
Remedial action 4% 1%<br />
Fee waived/reduced 4% 3%<br />
Procedural change 2% 5%<br />
Explanation offered 51% 62%<br />
Apology 2% 3%<br />
The most effective means of resolving complaints is where the provider responds in a<br />
timely and empathetic way. An apology, where appropriate, is also useful. Most<br />
people who do lodge complaints want to know what went wrong and why, and<br />
they want to make sure the same thing does not happen to someone else. In<br />
other words, they are seeking quality improvements.<br />
A man lodged a complaint about a podiatrist because the podiatrist had been<br />
rough, he hurt him and made his toe bleed. The man wanted his money<br />
refunded. The HSC sent the complaint to the podiatrist who contacted the man<br />
and said he would refund the service fee. He also apologised. The podiatrist<br />
refunded the money quickly and within five days of receiving the complaint it<br />
was closed with both parties satisfied with the outcome.<br />
RESOLUTION BY INVESTIGATORS<br />
The Investigators’ role includes acting as team leaders for the Inquiry Officers and<br />
this means the reading and accepting or declining of all new complaints into the office<br />
and giving advice on the management of accepted complaints.<br />
Most complaints (approximately two thirds) are resolved in the initial stages by<br />
sending them to the service provider and asking for a response. Those that are not<br />
resolved by this process are then assessed by the Investigators to see how they might<br />
be resolved.<br />
The options for resolution are informal resolution during assessment, referral to<br />
conciliation or investigation by the <strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> or external referral<br />
to a professional registration board.<br />
Resolution during assessment might involve the investigator contacting other treating<br />
health services, obtaining medical records and reports, seeking expert opinions and<br />
conducting meetings between the parties. Complainants may be assisted to obtain<br />
their own evidence to support their case where they remain dissatisfied with<br />
explanations offered by the service providers.<br />
A family complained to the HSC, following the death of an elderly man, that his<br />
general practitioner had failed to diagnose and treat his condition. The man had<br />
collapsed and had been admitted to hospital but had died soon after admission.<br />
The cause of death was heart failure that had been present for a number of<br />
years.<br />
In his response to the family, the general practitioner said that his patient had<br />
been well aware of his heart condition but had declined to have any treatment<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 28
other than medication to manage his blood pressure. The family found it hard to<br />
accept that their father would have kept his condition hidden from them and<br />
wanted to pursue their complaint.<br />
In assessment, the investigator spoke first to the general practitioner, and then to<br />
a cardiologist who had seen the man for regular check ups. The cardiologist<br />
agreed to speak to the man’s family. The records were discussed and the<br />
cardiologist was able to confirm that it had been his patient’s wish that his family<br />
were not “burdened” with information about his illness. The family accepted<br />
the man’s care had been appropriate and the case was closed.<br />
Complaints are referred to conciliation if the parties agree to the process and their<br />
understanding of the issues to be addressed is similar. Commonly, issues of<br />
compensation would be referred to a conciliator but other issues might also be<br />
addressed.<br />
Many health service professionals are registered providers. This means they must be<br />
registered to work in their profession. Examples of registered providers are doctors,<br />
nurses, dentists and psychologists. Referrals to professional boards occur where there<br />
appears to be an issue of professional standards to be considered or where the matter<br />
is clearly not suitable for conciliation. If a registered service provider refuses to<br />
respond to a complaint, or responds inappropriately, sometimes a referral to the<br />
relevant board is the only option.<br />
The attitude of the complainant is also a deciding factor in whether a complaint needs<br />
to be referred to a Board. If the complainant is not conciliatory and is seeking a<br />
disciplinary outcome, or a judgement from the profession, these are outcomes that<br />
may be more appropriately pursued through the boards.<br />
Where a matter is not suitable for conciliation but is related to an unregistered<br />
provider, the <strong>Commissioner</strong> may ask an investigator to conduct a formal investigation.<br />
The investigator acts as the <strong>Commissioner</strong>’s delegate in collecting evidence to decide<br />
if a complaint is justified. Investigation includes powers to require attendance and the<br />
production of documents, hear evidence on oath and obtain warrants to inspect<br />
premises and examine witnesses. After an investigation the <strong>Commissioner</strong> will make<br />
recommendations for the resolution of a complaint.<br />
In fulfilling these roles, the investigators rely on the assistance of a range of<br />
professionals who provide expert advice in the resolution of complaints. This<br />
assistance is greatly appreciated by the <strong>Commissioner</strong> and her staff.<br />
In the year <strong>2000</strong>/<strong>2001</strong>, 476 complaints were not resolved in the initial stages and so<br />
were referred on to investigators for assessment. Of these, 306 (65%) were resolved<br />
in the assessment stage, 97 (20%) were referred on to conciliation and 73 (15%) to<br />
professional boards or other agencies.<br />
In <strong>2000</strong>/<strong>2001</strong>, the investigators resolved 304 or 10% of complaints. Of these, the<br />
greatest number (153) were resolved with a further explanation received from the<br />
provider.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 29
Investigators participate in policy development, in the training and/or orientation of<br />
hospital complaints liaison officers and other staff, and represent the <strong>Commissioner</strong> in<br />
giving talks and in training community and professional groups, and attendance at<br />
conferences.<br />
Table 6. Resolution by Investigators<br />
Outcome 1999/<strong>2000</strong> <strong>2000</strong>/01<br />
Declined 13% 12%<br />
Referred elsewhere 3% 2%<br />
Withdrawn by user 5% 2%<br />
Investigation unwarranted 1% 2%<br />
Unsubstantiated 14% 7%<br />
Remedial action 3% 4%<br />
Fee waived/reduced 7% 4%<br />
Procedural change 6% 3%<br />
Explanation offered 47% 59%<br />
Apology 1% 5%<br />
Investigators collect further information about complaints such as medical records,<br />
reports and opinions, so complaints are more frequently closed as unsubstantiated at<br />
this stage.<br />
CONCILIATION REPORT<br />
The year under review has been particularly challenging as preparations in the latter<br />
half were made for future changes that will significantly expand the conciliation team.<br />
Conciliation continues to be regarded by health service consumers and providers as a<br />
successful mechanism for the resolution of complaints, including matters that might<br />
otherwise be dealt with by litigation. Of all complaints unable to be resolved in the<br />
initial stages, 20% were referred to conciliation.<br />
The willingness of public and private hospital staff across the State to participate fully<br />
in the conciliation process, assists the timely resolution of hospital complaints to the<br />
satisfaction of the participants.<br />
Issues about communication continue to be a common cause of complaints. The open<br />
and honest exchange which is encouraged during the conciliation process goes a long<br />
way towards addressing these problems.<br />
An uninsured woman went to a public hospital as a private patient to give birth.<br />
Following the delivery, her daughter suffered complications and was taken to the<br />
special care nursery for treatment for a lengthy period of time. The woman's<br />
obstetrician referred the baby's management to a paediatrician of the same<br />
cultural background as the parents, to encourage smooth communication. The<br />
family were very happy with the paediatrician's care and thought it was all part<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 30
of the excellent service provided by the hospital. Subsequently, with both mother<br />
and baby safely home, the woman received bills from the hospital for herself and<br />
her daughter who was not covered by any private insurance. The woman's<br />
husband complained that she had not been given the option of deciding whether<br />
their daughter was to be treated as a public or private patient. In any case, the<br />
paediatrician who treated his daughter was also the consultant on duty.<br />
The hospital tried to reduce the bill by encouraging the paediatrician to accept<br />
the Medicare rebate only. However, the doctor refused on account of the<br />
succession of heated arguments that he had with the woman's husband. The<br />
hospital then instituted recovery proceedings. During the conciliation process it<br />
was discovered that the hospital staff had failed to arrange for the patient to elect<br />
the private/public status of the baby. They acknowledged that their<br />
communication procedures had failed. As a result they changed their admission<br />
processes and agreed to waive the outstanding account.<br />
Once again we would like to acknowledge the vital role of the independent<br />
consultants who provide opinions for conciliation purposes. The opinions are<br />
invariably provided willingly and are essential to the continued success of conciliation<br />
in the HSC.<br />
The conciliation process often involves close liaison with lawyers for all parties and<br />
relations with the legal firms involved have generally been excellent.<br />
As in previous years, senior conciliators continue to provide mentorship for the<br />
conciliators in the equivalent organisations interstate and this has resulted in a<br />
consistent approach to conciliation of health complaints.<br />
Table 7. Resolution by Conciliators<br />
Outcome 1999/<strong>2000</strong> <strong>2000</strong>/01<br />
Agreement reached 87% 89%<br />
Withdrawn by user 9% 8%<br />
Withdrawn to go to law 4% 3%<br />
REGISTRAR’S REPORT<br />
The major function of the Registrar for the year ending June <strong>2001</strong> was consulting with<br />
all registration boards in relation to consumer complaints. Internal case management,<br />
managing the enquiry function and considering Freedom of Information requests are<br />
also the responsibility of the Registrar. Three requests under the Freedom of<br />
Information Act 1982 were processed with full access being granted.<br />
The practice of registration boards faxing through to HSC all consumer complaints as<br />
soon as they are received for the purpose of early discussion, and referral where<br />
appropriate, has continued. Regular meetings with the Registrars of all Boards have<br />
been ongoing. This exchange of information has resulted in complaints received by<br />
boards which are suitable for conciliation by the HSC being referred to the<br />
<strong>Commissioner</strong> without delay and complaints received by the <strong>Commissioner</strong> which<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 31
may fall into the category of unprofessional conduct being referred by the<br />
<strong>Commissioner</strong> to the relevant registration board either following a response by the<br />
health service provider or upon receipt, dependent on the nature of the complaint.<br />
Sexual misconduct complaints are referred by the <strong>Commissioner</strong> when they are<br />
received. Although complaints are referred to boards, complainants are aware that,<br />
following a boards’ processes, they may approach the <strong>Commissioner</strong> for<br />
re-activation of their file in the event that unresolved issues remain which were not<br />
considered by a registration board. The health service provider is also aware of this<br />
possibility.<br />
During the period under review 73 complaints received by HSC were referred to<br />
Registration Boards. Of this, 59 were referrals to the Medical Practitioners Board of<br />
Victoria of a total of 1107 complaints received about the standard of care provided by<br />
medical practitioners.<br />
The Registrars Meetings which commenced in December 1998, continue to be held<br />
regularly. These meetings generate much interest and are seen as a useful forum for<br />
registrars of health registration boards to share ideas and plan for the provision of<br />
improved and enhanced services to consumers of health services as well as registrants.<br />
ABORIGINAL LIAISON OFFICER’S REPORT<br />
During the <strong>2000</strong>/<strong>2001</strong> year, the Aboriginal Liaison Officer (“ALO”) held a multifaceted<br />
role within the Office. She continued to promote the services of the Office to<br />
Aboriginal communities and attended to complaints from indigenous health service<br />
consumers. She also attended to mainstream enquiries and provided a consultative<br />
role to other staff members within the Office on culturally sensitive issues.<br />
In the year under review approximately 80 enquiries were received from Aboriginal<br />
and Torres Strait Islander people and 14 of these, went through the full HSC process.<br />
This is a considerable increase over previous years. These complaints covered a range<br />
of issues including:<br />
• access to medication and services<br />
• communication issues<br />
• discrimination<br />
• failure to consult<br />
• inadequate/wrong treatment<br />
• negligence<br />
• breaches of confidentiality.<br />
The majority of the complaints related to services received in public hospitals. There<br />
were also a number of complaints about general practitioner, pharmacy and<br />
community health services.<br />
A man who had recently been detained in custody complained that he was not<br />
being provided with access to appropriate medication for his epilepsy condition.<br />
He had initially spoken to the health service provider within the prison system,<br />
but claimed they would not allow him access to the particular medication he had<br />
been using prior to his detention. He complained to the HSC that the medication<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 32
he was being given (which he had previously tried) did not adequately control his<br />
condition and caused him significant side effects. Contact was made with the<br />
provider to clarify the situation. Following a number of discussions, the health<br />
service provider apologised and agreed that the man should have access to his<br />
usual medication.<br />
A woman complained to the HSC that she took her elderly mother to a public<br />
hospital after a fall at home. Her hip was x-rayed and a brain scan was taken as<br />
she had previously suffered a stroke. After 6 hours of waiting in accident and<br />
emergency for a diagnosis and treatment, the daughter had to leave to collect<br />
children after school. She was advised to take her mother with her because there<br />
were no beds available. However the daughter insisted that they look after her<br />
mother and undertook to return immediately. Nevertheless after waiting a total<br />
of 9 hours the elderly woman was sent home without medication or advice other<br />
than to return in a few days if pain persisted.<br />
The following day the daughter took her mother to their regular G.P. who<br />
arranged for immediate admission to hospital for an urgent operation. The<br />
complaint was sent to the provider and a response was sought. The provider met<br />
with the woman's daughter shortly after she had lodged the complaint with this<br />
Office. She discussed her concerns with the Director of Medical <strong>Services</strong> in the<br />
presence of the Koori Hospital Liaison Officer and it was acknowledged that her<br />
concerns were valid. The provider advised that it would emphasise the<br />
importance of the matters raised by the woman with Hospital staff. The woman<br />
contacted the Office to advise that she was satisfied with the action taken by the<br />
Hospital and did not want to pursue the matter any further.<br />
There were a number of visits to both Metropolitan and Country areas to raise the<br />
awareness of the Office amongst aboriginal communities. The HSC is committed to<br />
increasing awareness and accessibility for indigenous people and hopes to<br />
significantly increase these visits in the forthcoming year.<br />
PRISONER COMPLAINTS<br />
Complaints from prisoners have risen to 116 which is an increase of 50% over the<br />
same time last year. This is possibly due to prisoners increased awareness of the<br />
presence of the HSC. Five metropolitan and country prisons were been visited over<br />
the last 12 months, with further visits being planned up to 30 December <strong>2001</strong>. Again<br />
this has contributed to the increase in numbers of complaints.<br />
Issues prisoners complain about remain the same with the majority of complaints<br />
being about medication regimes, waiting times to access services, and general<br />
treatment issues.<br />
A prisoner complains of not yet having seen a dentist when he had lodged an<br />
application to see one 7 weeks previously.<br />
A prisoner complained about not having access to medication (Rivitril 2mg).<br />
Prior to being incarcerated, the prisoner took this medication to alleviate<br />
behavioural problems.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 33
Prisoners remain reluctant to transfer from one facility to another for tertiary<br />
medical/dental treatment.<br />
The protocols set up between HSC, the State Ombudsman and the Prisoner <strong>Health</strong>care<br />
Unit at the Department of Human <strong>Services</strong> remain effective, with the Ombudsman<br />
routinely forwarding complaints received about health service provision to the HSC<br />
and the Prisoner <strong>Health</strong> Care Unit being routinely notified of complaints.<br />
Figure 3. Prisoner Complaints<br />
98/99<br />
Prisoner Complaints<br />
12<br />
23<br />
99/00<br />
00/01<br />
36<br />
2<br />
1<br />
1<br />
2<br />
2<br />
9<br />
16<br />
33 35 62<br />
Access Admin Communication Cost Rights Treatment<br />
OUTCOMES<br />
HOW WERE THE COMPLAINTS RESOLVED?<br />
During the period under review 2978 complaints were closed. Eighty four percent<br />
(2504) were handled at the point of service or locally, that is, between the health<br />
service provider and the user of the service. A further ten percent (304) were finalised<br />
at the assessment stage and three percent (97) closed in conciliation. Two percent (73)<br />
of cases were referred to registration boards or other agencies.<br />
Table 8. Complaint Resolution by Stage<br />
Stage of Complaint Process Number of Complaints<br />
Enquiry Stage 2504<br />
Assessment 304<br />
Conciliation 97<br />
Referral to Registration Boards & other<br />
73<br />
Agencies<br />
Total Number of Complaints 2978<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 34
REASONS FOR COMPLAINTS<br />
Complaints received by the <strong>Commissioner</strong> are classified according to their underlying<br />
issues. The broad categories are as follows:<br />
Access<br />
Treatment<br />
refers to availability of services in terms of location, waiting<br />
times and other constraints that limit use of the service;<br />
refers to diagnosis, testing, medication and other therapies<br />
provided;<br />
Communication<br />
Cost<br />
Rights<br />
Administration<br />
refers to manner of communication such as rudeness,<br />
disinterest, quality and quantity of information provided about<br />
treatment, risks and outcomes and prognosis;<br />
refers to information about costs and fees, discrepancies<br />
between advertised and actual costs, charges and rebates;<br />
refers to rights to privacy and dignity, consent to treatment,<br />
reasonable access to records; and<br />
refers to support services for providers such as reception,<br />
waiting lists, cleaning services, etc.<br />
Most complaints identify only one of these as an issue but approximately one in three<br />
raises concerns about more than one issue. Please note that in 114 complaints an issue<br />
was not specified.<br />
Primary issues in complaints <strong>2000</strong>/<strong>2001</strong><br />
While the most frequently nominated issue was treatment nearly all complaints also<br />
include failures of communication. This year complaints about treatment accounted<br />
for 57% of all complaints, a total of 1583 compared with 1356 complaints in<br />
1999/<strong>2000</strong>. Inadequate treatment complaints featured most prominently.<br />
Table 9. Treatment<br />
Treatment 57%<br />
Inadequate diagnosis 191<br />
Inadequate treatment 585<br />
Medication 149<br />
Negligent treatment 285<br />
Other 72<br />
Rough treatment 57<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 35
Unskillful/incompetent treatment 147<br />
Wrong diagnosis 75<br />
Wrong treatment 22<br />
Total Treatment 1583<br />
The largest number of complaints about medical practitioners and hospitals were in<br />
the area of inadequate treatment. Many of these complaints could have been avoided<br />
if more care had been taken to listen to the concerns of the patients and/or the carers<br />
and, to conduct a more thorough examination.<br />
A woman took her infant son to a medical clinic on a Sunday morning as the<br />
child had been vomiting all night. She was seeking treatment for the child and<br />
reassurance that she was managing him appropriately. It took an hour before<br />
she saw a doctor and when the doctor did finally see her, he asked her what she<br />
had come for? She explained the child had been very sick all night. The doctor<br />
did not examine the child and was curt with the woman, saying she should not be<br />
bothering him and if she had concern about her infant she should take the child<br />
to casualty at the nearest hospital. No treatment or advice was given.<br />
Table 10 below sets out the communication issues. Communication continues to be a<br />
serious problem.<br />
Table 10. Communication<br />
Communication 13%<br />
Absence of caring 64<br />
Failure to consult 59<br />
Inconsiderate/undignified service 76<br />
Other 33<br />
Poor attitude/discourtesy 77<br />
Wrong/misleading information 41<br />
Total Communication 350<br />
The number of complaints identified as being primarily about communication issues<br />
increased from 331 in 1999/<strong>2000</strong>, to 350 in <strong>2000</strong>/<strong>2001</strong>. Once again the most<br />
frequently mentioned communication issue is poor attitude and discourtesy. As<br />
mentioned in previous <strong>Annual</strong> <strong>Report</strong>s a study by HSC investigator, Lynn Griffin, has<br />
established that there are elements of communication problems in every complaint<br />
received and this continues to be an issue in the resolution of complaints.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 36
A young female patient went to consult a dentist about stain removal from her<br />
teeth. The dentist said he could clean and de-scale her teeth and she agreed to<br />
the procedure, but warned him that she was very anxious and could become<br />
panicky if she thought she could not breathe during the treatment. The dentist<br />
told her if she became distressed for any reason she should simply raise her left<br />
hand and signal to him. She did this twice during the treatment and the dentist<br />
stopped as agreed and allowed her to sit up and take a break. On the third<br />
occasion he became angry, threw an instrument across the room, swore at her<br />
and told her she was too pathetic to help and to go elsewhere for her treatment.<br />
When contacted by the HSC the dentist claimed he was an excellent<br />
communicator and no-one else had ever complained about him. He accused the<br />
woman of having mental problems. He said, he would not respond to her in<br />
writing as it was too much trouble and she was the one in the wrong. Because of<br />
this response, the matter was not suitable for conciliation and was referred to the<br />
Dental Practice Board of Victoria. After speaking with the Board and his<br />
professional association the dentist telephoned the HSC and offered to apologise<br />
to the woman and refund her fee.<br />
A man went to a naturopath because of pain in his shoulders from playing golf.<br />
The naturopath massaged the man’s shoulders and manipulated his neck. He<br />
felt an immediate sharp pain which worsened over the next few days. He went<br />
back to the naturopath who explained he might feel worse for a while before he<br />
began to feel better. The pain decreased over time and eventually disappeared,<br />
but the man felt angry he had not been warned of the possibility of the pain<br />
becoming worse. He had also been fearful some permanent harm had occurred.<br />
The naturopath agreed she had not warned him adequately on this occasion,<br />
although she normally did do this. She agreed to refund the fees he had paid her<br />
and he decided not to pursue the matter further.<br />
Table 11 below shows the types of complaints made in relation to rights.<br />
Table 11. Rights issues<br />
Rights 10%<br />
Accuracy of records 9<br />
Access to records 20<br />
Assault 35<br />
Discrimination 17<br />
No/insufficient consent 19<br />
Unprofessional conduct 45<br />
Other 21<br />
Privacy/confidentiality 64<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 37
Refusal to treat 43<br />
Total Rights 273<br />
Rights issues accounted for 273 or 10% of all complaints compared with 225 for<br />
1999/<strong>2000</strong>. Rights issues included breaches of confidentiality and privacy,<br />
unprofessional conduct and failure to provide reasonable access to records. The<br />
access to records problem will be addressed next year when the <strong>Health</strong> Records Act<br />
<strong>2001</strong> comes into force, giving users of health services a legally enforceable right of<br />
access to health information about them.<br />
A woman complained her GP sent irrelevant information to a specialist. She had<br />
had a traumatic, abusive childhood and once, many years ago, harmed herself.<br />
Many years later, following a car accident, she sought a referral in order to see a<br />
rheumatologist. The referral letter included the self harm incident. The woman<br />
believes this information should not have been passed on. After the doctor<br />
explained his clinical reasons for passing on the information and apologised for<br />
not having discussed the matter with her beforehand, she was satisfied and<br />
decided not to pursue the matter further.<br />
A man complained that the receptionist at a medical clinic discussed his son’s<br />
outstanding bill during a social club gathering. The receptionist denied the<br />
allegation. However during investigations by the HSC witnesses to the<br />
conversation in question confirmed the complainant’s story. At a conciliation<br />
meeting, the receptionist apologised to the complainant and his son. The<br />
practice manager reassured the family that this would never happen again and<br />
agreed to waive part of the outstanding bill.<br />
Table 12 below sets out access issues raised in complaints<br />
Table 12. Access issues<br />
Access 10%<br />
Delay in admission 40<br />
Delay in treatment 55<br />
Discharge arrangements 15<br />
Transfer 18<br />
Non attendance 36<br />
No/Inadequate service 77<br />
Other 8<br />
Refused admission 9<br />
Refused to refer 1<br />
Transport 2<br />
Waiting list 9<br />
Total Access 270<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 38
Complaints about access to services increased in the year under review to 270 or 10%<br />
compared with 197 in 1999/<strong>2000</strong>. Issues raised included unavailability of services or<br />
treatment/admission delays.<br />
A man was diagnosed with a serious condition requiring urgent surgery. His<br />
family complained his surgery had been cancelled on three occasions and the<br />
man was too fearful to leave his home, thinking he could die at any minute. The<br />
HSC contacted the complaints liaison officer of the Hospital and discussed the<br />
issues with her. She agreed to make inquiries on the man’s behalf. The Hospital<br />
explained that a special device needed to be manufactured for the surgery and<br />
this was where the delay had occurred. Soon after the family contacted the HSC<br />
to say the surgery had been successful and the man was recovering well.<br />
Table 13 below sets out the cost issues raised in complaints.<br />
Table 13. Cost issues<br />
Cost 5%<br />
Amount charged 23<br />
Billing practices 61<br />
Fraud 0<br />
Information on costs 24<br />
Other 8<br />
Over-servicing 13<br />
<strong>Health</strong> insurance 4<br />
Public/private election 5<br />
Total Cost 138<br />
There were 119 complaints about costs in 1999/<strong>2000</strong>, compared with 138 or 5% this<br />
year. Complaints about costs are not accepted unless the complaint raises issues in<br />
addition to costs. Once again, communication is important. As noted in last year’s<br />
<strong>Annual</strong> <strong>Report</strong> it would be helpful if health service providers posted lists of charges in<br />
waiting areas. Members of the public also have a responsibility to ask about costs<br />
before agreeing to a service, although this is not possible in emergency situations.<br />
The predominant complaints about costs were billing practices and amounts charged.<br />
A woman arranged to buy some reading glasses from an optometrist. She paid a<br />
small deposit and agreed to pay off the balance over a three month period. The<br />
optometrist told her he would not start making the glasses until she paid most of<br />
the fee. Soon afterwards she learned she was entitled to have the cost of reading<br />
glasses subsidised through a government program, so she went back to cancel the<br />
order. The optometrist told her the glasses had already been made and she<br />
would have to pay the full account. She complained to HSC who negotiated the<br />
account to be waived. The optometrist agreed, in future, he would advise such<br />
patients of the existence of the government funded program.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 39
A woman contacted HSC because she had not expected to pay the fee the doctor<br />
charged. She had been to the same doctor many times and considered there<br />
should be some notice that charges had been amended. The concerns were sent<br />
to the clinic which has now placed a notice of charges on the reception desk.<br />
A man was referred to a specialist. He contacted HSC after his operation and<br />
said he had never been informed of all the charges involved with his operation.<br />
The concerns were sent to the doctor. The doctor now provides an information<br />
sheet that advises the item numbers, the amount he charges and the amount the<br />
patient will get back from Medicare. He also advises the names of the anesthetist<br />
and suggests patients contact them to confirm costs. Hospital charges are also<br />
outlined.<br />
Table 14 shows the administration issues in complaints.<br />
Table 14. Administration issues<br />
Administration 2%<br />
Management Practices 20<br />
Failure to provide certificate 2<br />
No/inadequate response 5<br />
Other 17<br />
Public health standards 13<br />
Policy 1<br />
Total Administration 58<br />
There were 58 complaints in <strong>2000</strong>/01 about administration issues in health services<br />
compared with 71 in 1999/<strong>2000</strong>. These complaints are about the ways in which<br />
services are run rather than the medical or health components of services. Complaints<br />
include public health standards.<br />
A young man from Fiji needed reports and x-rays to present to the Immigration<br />
Department. He had x-rays done at a private practice and paid $150. These<br />
were sent to the health service which did more tests which cost him $168.00. The<br />
health service assured the man the documents would be sent to the Immigration<br />
Department as he requested. The documents were never received and the staff<br />
said the documents were lost and all tests would need to be repeated and reports<br />
re-done. In response to a complaint to the HSC, the manager of the health<br />
service apologised in writing and forwarded a cheque to cover all additional<br />
expenses.<br />
An inpatient at a private hospital experienced extreme cold and draughts when<br />
the heating malfunctioned on a very cold night. The man's brother contacted the<br />
hospital to speak to the CEO. The staff member who rang back was very off<br />
hand and uncaring about the incident. Although the problem was rectified, the<br />
patient later experienced draughts again and was moved to another room. After<br />
intervention by the HSC, the hospital responded directly to the complainant and<br />
explained that a fan at the top of the window was causing the problem and has<br />
since been removed.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 40
CATEGORIES OF COMPLAINTS AGAINST HEALTH SERVICE<br />
PROVIDERS<br />
Medical practitioners represented 40% of health service providers complained about<br />
followed by hospitals at 32%, dentists at 7% with the remainder representing 21%.<br />
Figure 4. Categories of complaints against health service providers.<br />
Categories of Complaints against <strong>Health</strong><br />
Service Providers<br />
Not specified<br />
6%<br />
Remaining<br />
Providers<br />
15%<br />
Hospitals<br />
32%<br />
Dentists in Private<br />
Prac.<br />
7%<br />
Medical<br />
Practitioners<br />
40%<br />
Private medical practitioners continue to be the subject of most complaints however<br />
they are, by far, the largest provider group. There was an increase in the number of<br />
complaints this year (1107) by comparison with last year, 994. The percentage of<br />
complaints about doctors remained at 40%. Public hospitals are the next largest<br />
category. Complaints about employees of public hospitals are always recorded as a<br />
complaint against the institution rather than the individual. Doctors working from<br />
private hospitals, however, are considered to be private practitioners. There is often<br />
confusion about responsibility, or shared responsibility, when a person complains<br />
about the treatment received in a private hospital.<br />
MEDICAL PRACTITIONERS<br />
The category “medical practitioners” includes all doctors whether in specialist service<br />
provision or general practice. The most common issues in these complaints related to<br />
treatment, but communication is nearly always an underlying issue.<br />
Figure 5 below sets out the types of complaints about treatment made against medical<br />
practitioners over the past two years.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 41
Figure 5. Treatment Issues – Medical Practitioners<br />
Treatment Issues - Medical Practitioners<br />
00-01<br />
Incompetent treatment<br />
Rough treatment<br />
3%<br />
2%<br />
9%<br />
13%<br />
99-00<br />
Other<br />
4%<br />
3%<br />
Negligent treatment<br />
8%<br />
17%<br />
Medication<br />
Inadequate treatment<br />
9%<br />
11%<br />
36%<br />
34%<br />
Inadequate diagnosis<br />
23%<br />
28%<br />
The largest group of doctors is the general practitioners (GPs). In 1999/<strong>2000</strong> almost<br />
half (544) of all complaints against doctors were made about GPs. In <strong>2000</strong>/<strong>2001</strong> this<br />
decreased to 534. Figure 6 below shows the categories of complaints made against<br />
GPs for the past two years.<br />
Appendix 2 lists the number of complaints about individual medical specialities<br />
GENERAL PRACTITIONERS<br />
Once again the most common issues in complaints about GPs relate to treatment<br />
issues, usually inadequate treatment and diagnosis, however attitudinal problems and<br />
poor communication occur far too often and have the potential to undermine public<br />
confidence in the medical profession.<br />
Figure 6. Issues in GP Complaints<br />
Issues in GP Complaints<br />
00-01<br />
99-00<br />
Access<br />
8%<br />
6%<br />
Administration<br />
2%<br />
2%<br />
Communication<br />
21%<br />
19%<br />
Cost<br />
4%<br />
5%<br />
Rights<br />
13%<br />
14%<br />
Treatment<br />
51%<br />
53%<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 42
A woman and her sick child were kept waiting for two hours at a general<br />
practice clinic. The child became distressed and started to cry. The receptionist<br />
asked the woman to take the child outside because, she said, the crying was<br />
upsetting other patients. The woman demanded to see the doctor who was<br />
rushed. He said there was nothing wrong with the child and sent them away.<br />
That night the child required admission to the emergency unit of the hospital.<br />
The doctor steadfastly refused to apologise, so the HSC could not resolve the<br />
complaint and referred it to the Medical Practitioners Board of Victoria for<br />
investigation.<br />
A doctor in a busy rural practice was over booked. A woman and her baby<br />
waited for two and a half hours to be seen. The examination was cursory and<br />
they were sent home. Subsequently, the baby was admitted to hospital with a<br />
serious infection. In response to the woman’s complaint the doctor apologised<br />
and explained the changes he had made in appointment booking practices, so the<br />
problem should not occur again. The complainant was satisfied with the<br />
outcome and the file was closed.<br />
DENTISTS<br />
There were 195 complaints against dentists this year, 10 less than last year. As in<br />
previous years, most complaints were resolved at the enquiry stage. Seventy-four of<br />
these complaints were the subject of formal assessments by HSC. Treatment issues<br />
accounted for approximately 80% of the complaints with communication and cost<br />
cited in the remaining 20% of complaints.<br />
Figure 7. Treatment Issues Dentists<br />
Treatment Issues Dentists<br />
inadequate diagnosic<br />
Inadequate treatment<br />
Medication<br />
0%<br />
4%<br />
5%<br />
37%<br />
36%<br />
Negligent treatment<br />
Other<br />
Rough treatment<br />
Unskilful treatment<br />
Wrong diagnosis<br />
Wrong treatment<br />
2%<br />
3%<br />
3%<br />
1%<br />
3%<br />
2%<br />
4%<br />
6%<br />
18%<br />
23%<br />
23%<br />
30%<br />
00/01<br />
99-00<br />
Of the 74 complaints dealt with formally by HSC, 41 were closed during the report<br />
period.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 43
Root canal therapy and cosmetic dentistry continue to account for a large number of<br />
complaints about dentists. The complexity of root canal treatment is not well<br />
understood and the treatment is usually lengthy and expensive. When problems occur<br />
communication needs to be particularly sensitive.<br />
A man agreed to have root canal treatment to an upper molar. After six visits<br />
the pain persisted. The tooth was X-rayed and a fine fracture was detected. He<br />
then elected to have the tooth extracted but was given a large bill for the root<br />
canal work<br />
Although there have been fewer complaints about dentures, they continue to be<br />
difficult to resolve. Functional problems cause the wearer great distress particularly<br />
when it is difficult to explain why a good fit is difficult to achieve.<br />
A woman had her upper denture replaced. Despite several relines she is unable<br />
to wear the denture. She had lost weight and was unwilling to attend social<br />
functions where food was served.<br />
The HSC is grateful for the assistance provided by the Dental Practitioners Board of<br />
Victoria and by the Australian Dental Association, Victorian Branch.<br />
DENTAL TECHNICIANS<br />
There were 22 complaints against dental technicians, 1 more than for the last report<br />
period.<br />
All these complaints were about unsatisfactory dentures.<br />
A man had an upper and lower denture made for him by a dental technician.<br />
Although the upper denture was functional, the lower denture was causing so<br />
much pain he could not eat while it was in place. A number of relines to the<br />
lower denture improved its function slightly. He was unhappy with the<br />
additional $250 bill for the reline.<br />
Informed consent remains an issue in these complaints. If more time was taken to<br />
explain the procedures, the risks associated with them and the costs involved, many of<br />
the complaints would not occur.<br />
HOSPITALS<br />
Complaints made to the HSC about hospitals<br />
Public hospitals attracted 86% (755) of total hospital complaints made to the HSC and<br />
private hospitals accounted for 14% (121). Hospitals, both public and private, made<br />
up 31% of the total complaints received by the HSC in the <strong>2000</strong>/<strong>2001</strong> period.<br />
All public hospitals are required to have internal complaint handling systems. For this<br />
reason a large number of complaints are handled in-house and do not need to be<br />
referred to the HSC. Public hospitals are required to provide details of complaints to<br />
the <strong>Commissioner</strong> on a regular basis and these figures are reported in the section on<br />
the <strong>Health</strong> Complaints Information Program. The work of complaints liaison officers<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 44
or patient representatives at the hospital level in complaints resolution is most<br />
important. (See also Public Interest Issues, Complaints Liaison Officers on page 20<br />
of this report.<br />
Figure 8 shows the number of complaints made by inpatients and outpatients of public<br />
hospitals directly to the HSC.<br />
Figure 8. Public/Private Hospital Comparisons<br />
Hospital Complaints 755<br />
121<br />
Private Hospital<br />
Public Hospital<br />
Figure 9. Public Hospital by Patient Type<br />
Public Hospital Complaints<br />
Not specified<br />
28%<br />
Inpatient<br />
41%<br />
Outpatient<br />
31%<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 45
PUBLIC HOSPITAL ISSUES<br />
Figure 9 shows the issues that made up complaints to the HSC about public hospitals.<br />
The most frequent issue complained about is treatment (58%). Other issues are access<br />
(16%), communication (10%), rights (9%), administration (2%) and cost (2%).<br />
Figure 10. Public Hospital Complaints<br />
Public Hospital Issues<br />
Treatment<br />
Rights<br />
Cost<br />
Communication<br />
Administration<br />
Access<br />
Not specified<br />
2%<br />
2%<br />
3%<br />
9%<br />
10%<br />
16%<br />
58%<br />
A man attended a diagnostic imaging service located in a hospital in a rural city.<br />
He was very angry to receive a bill for the x-rays taken, saying he was a public<br />
patient and he should not have to pay. His complaint was sent to the hospital<br />
CEO who explained the diagnostic imaging service was privately run from<br />
hospital premises and the complaint had been referred onto the manager of the<br />
service. The manger said, there were many signs in the rooms including a large<br />
one on the reception desk explaining fees would be charged and these were<br />
rebateable through Medicare. This was explained to the man who decided not to<br />
pursue his complaint further.<br />
PRIVATE HOSPITALS<br />
In <strong>2000</strong>/01 there were 121 or 14% of hospital complaints made about private hospitals<br />
compared with 116 in 1999/<strong>2000</strong>. As with previous years treatment issues remain the<br />
most common. In the case of private hospitals the treatment issues relate to staff other<br />
than doctors because these hospitals do not employ their own doctors.<br />
Figure 11 below shows the main issues in complaints against private hospitals. The<br />
most frequent issue complained about is treatment with 65 complaints. Other issues<br />
are cost 9, communication 16, administration 5, access 11 and rights 10.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 46
A woman who was booked into a small private hospital for the birth of her first<br />
child had discussed with her doctor her wish to have an epidural for pain<br />
management. On the day of her admission the Hospital was unable to locate a<br />
suitable anaesthetist and she had to deliver her baby without the epidural. The<br />
Hospital explained they did not employ doctors but kept a list of on-call<br />
specialists. Unfortunately, no-one was available at the time of her admission as it<br />
had been a holiday weekend and two of the specialists had been at an overseas<br />
conference. The Hospital said it would expand its list of on-call doctors to avoid<br />
future problems.<br />
A woman complained, on behalf of her frail elderly father, who was an in-patient<br />
in a private hospital awaiting placement in a nursing home. On two occasions he<br />
was taken for diagnostic tests - a chest x-ray and an ultrasound. Each time he<br />
queried the staff as to why he needed the tests. They ignored him but afterwards<br />
checked his arm band and realised that he was not the patient who needed these<br />
investigations. The man raised it with his physician but was ignored and made<br />
to feel as if it were his fault. His daughter complained to the HSC. The provider<br />
responded acknowledging their error. They assured the complainant that the<br />
matter had been discussed at all the relevant committees to highlight the<br />
complaint and to ensure that this type of incident did not reoccur. The<br />
complainant was satisfied with the response.<br />
A woman underwent a diagnostic test in a private hospital. When she was<br />
getting down off the trolley she slipped and fell. As a result, she broke her toe<br />
and had to undergo extensive treatment. Following a complaint to the HSC, the<br />
hospital agreed to provide all necessary care including accommodation and<br />
crutches free of charge. They also agreed to the reimbursement of the cost of<br />
taxis to and from her treatment.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 47
Figure 11 Private Hospital Issues<br />
Private Hospital Issues<br />
Treatment<br />
56%<br />
Rights<br />
Cost<br />
8%<br />
7%<br />
Communication<br />
13%<br />
Administration<br />
4%<br />
Access<br />
9%<br />
Not specified<br />
3%<br />
PSYCHIATRIC SERVICES<br />
In the past year, there were 180 complaints lodged against a number of psychiatric<br />
services and against psychologists.<br />
Figure 12. Psychiatric <strong>Services</strong> Complaints<br />
Psychiatric <strong>Services</strong><br />
180<br />
164<br />
1999/<strong>2000</strong> <strong>2000</strong>/<strong>2001</strong><br />
Figure 13 below shows the numbers of complaints made against each type of service.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 48
Figure 13. Types of Service<br />
Types of <strong>Services</strong><br />
85<br />
49<br />
26<br />
5 7<br />
8<br />
Private Hosp CAT Teams Comm Centre Psychiatrists Public Hosp Psychologists<br />
Complaints against CAT Teams (7) remained the same as the previous year.<br />
Complaints against psychiatric care in public hospitals increased from 73 in<br />
1999/<strong>2000</strong> to 85 for <strong>2000</strong>/<strong>2001</strong>. Five complaints were made against private<br />
psychiatric hospitals, although such complaints would normally be made against the<br />
admitting doctor. There were 49 complaints lodged against psychiatrists, 2 more than<br />
were recorded in the previous year. Complaints against psychologists decreased from<br />
12 in 1999/<strong>2000</strong> to 8 in the period under review.<br />
ISSUES IN PSYCHIATRIC SERVICE COMPLAINTS<br />
Figure 14 below shows the primary issues identified in the 180 complaints received in<br />
the last year.<br />
Figure 14. Issues in Psychiatric Complaints<br />
Issues in Complaints<br />
88<br />
24 26<br />
35<br />
2<br />
5<br />
Access Communication Cost Rights Treatment Not Spec<br />
The majority of complaints about psychiatric services are about issues of treatment<br />
and patient rights. Some complainants who have been admitted for psychiatric care<br />
in hospitals feel aggrieved they are required to take medication they feel causes<br />
upsetting side effects. Others do not believe that they require medical treatment. The<br />
HSC does not have jurisdiction to intervene in cases involving involuntary status.<br />
Complainants are advised of their right to appeal to the Mental <strong>Health</strong> Review Board.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 49
A small number of people complain to the <strong>Commissioner</strong> about breaches of the<br />
human rights, including complaints about breaches of confidentiality, assault and<br />
unprofessional conduct by staff. These issues can be difficult to resolve, as there is<br />
often a difference in perception between the service staff and the complainant about<br />
what might constitute reasonable care and treatment.<br />
People with mental illness have the same rights to quality health care as all other<br />
patients and this should never be diminished by the fact they are sometimes unable to<br />
consent to their treatment and care.<br />
The HSC is often contacted by the families of people with mental illness who are<br />
concerned about the lack of information provided to them about Mental <strong>Health</strong><br />
Review Board hearings and/or their son/daughters illness. If the person has sufficient<br />
capacity to make decisions for themselves then staff must respect patient<br />
confidentiality. In 1996, there was a concession made to carers with the amendment<br />
of the Mental <strong>Health</strong> Act 1926, section 120A. This section of the Act allows staff to<br />
provide some information about patients which would otherwise have been<br />
confidential to primary carers where the information is required for the ongoing care<br />
of the person.<br />
HOSPITALS’ COMPLAINT DATA<br />
COMPLAINTS MADE AT PUBLIC HOSPITALS<br />
Information contained in this section has been compiled from complaints lodged<br />
directly with the CLOs of public hospitals. They utilise the <strong>Health</strong> Complaints<br />
Information Program (HCIP) to record and monitor complaints handled locally within<br />
the hospital. These complaints are separate to those lodged with the HSC.<br />
The following trends are taken from data provided by 37 public hospitals<br />
WHO COMPLAINED AND HOW?<br />
Fifty-nine percent of complainants were female and were 39% male. As expected<br />
public patients were the largest group (94%) and private patients (3%). The majority<br />
of complaints were made via letter or telephone call (35% each), 25% by personal<br />
visit and 5% by other means.<br />
The age and gender profile of complainants is shown in Table 15 below<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 50
CONSUMER PROFILE<br />
Table 15. HCIP - Age/Gender analysis<br />
Age Female Male Not Specified Total<br />
Under 1 6 14 4 24<br />
1 – 4 19 23 0 42<br />
5 – 14 14 27 9 50<br />
15 – 24 116 66 2 184<br />
25 – 34 237 86 0 323<br />
35 – 44 306 166 0 472<br />
45 – 54 260 181 0 441<br />
55 – 64 241 155 1 397<br />
65 – 74 121 104 4 229<br />
75 – 84 144 85 1 230<br />
85 – 94 21 42 0 63<br />
95+ 1 2 0 3<br />
Not Specified 1623 1127 67 2817<br />
Total 3109 2078 88 5275<br />
Figure 15. HCIP - Gender<br />
Male<br />
39%<br />
Consumer Gender<br />
Not Specified<br />
2%<br />
Female<br />
59%<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 51
Figure 16. HCIP - Patient type<br />
Patient Type<br />
TAC<br />
Dept of Vet Affairs<br />
Inelligible Patient<br />
Not specified<br />
Private Patient<br />
50<br />
63<br />
3<br />
3<br />
175<br />
Public Patient<br />
4981<br />
WHAT WAS THE COMPLAINT ABOUT?<br />
During the period under review hospitals received, and dealt with, 5246 complaints<br />
concerning 13789 issues. That is, there were 2.6 issues per complaint received and<br />
addressed by the hospital complaints liaison officers (or patient representatives). A<br />
complaint may be multi-faceted and be concerned with not only poor communication<br />
but also inadequate treatment. The diagram below shows the issues in complaints. A<br />
more specific table of these issues appears as Appendix 3.<br />
Figure 17. HCIP - Issues<br />
HCIP Issues in Complaints<br />
Treatment<br />
23%<br />
Access<br />
34%<br />
Rights<br />
8%<br />
Cost<br />
3%<br />
Communication<br />
27%<br />
Administration<br />
5%<br />
Access and communication were the two commonest issues in complaints, being 34%<br />
and 27% respectively, followed by treatment (23%).<br />
At the end of the period, of 2325 issues, 2019 had been closed. The median days to<br />
closure were 12.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 52
THE SITE AND SERVICE PROVIDED AT TIME OF THE COMPLAINT?<br />
Thirty five percent of complaints occurred in the wards, 21% in the emergency<br />
department and 15% in outpatient clinics.<br />
Figure 18. HCIP - Site<br />
Not specified<br />
Ward<br />
Outpatient Clinic<br />
Operating Theatre<br />
Intensive Care Unit<br />
Hospital Grounds<br />
Emergency Dept<br />
Day Unit Procedure<br />
Aged Care<br />
Admissions<br />
592<br />
350<br />
373<br />
554<br />
105<br />
499<br />
1470<br />
Site<br />
2102<br />
2878<br />
4866<br />
SERVICES<br />
Six services received 37% of complaints. Twenty two percent (2359 complaints) were<br />
about emergency services, 6% (874 complaints) were regarding orthopaedic surgery,<br />
7% concerned general medicine, 8% about general surgery and 2% psychiatry.<br />
Appendix 4 gives a complete service analysis.<br />
Figure 19 HCIP - <strong>Services</strong><br />
Emergency<br />
22%<br />
<strong>Services</strong><br />
Psychiatry<br />
2%<br />
General Surgery<br />
10%<br />
General Medicine<br />
10%<br />
Remaining <strong>Services</strong><br />
48%<br />
Orthopaedic<br />
Surgery<br />
8%<br />
HOW SERIOUS WERE THE COMPLAINTS?<br />
Ten percent of complaints were categorised as serious or substantial and 63% as<br />
routine. The remainder were listed as either minor or trivial.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 53
INFORMATION TECHNOLOGY<br />
Hardware Improvements<br />
As the IT environment is constantly evolving it is necessary to continually review and<br />
improve the office equipment. Improvements made in <strong>2000</strong>/<strong>2001</strong> include:<br />
• Purchase of new computers for all staff to meet Government standards<br />
• Purchase of a laptop for use by office staff<br />
Office Database<br />
After rigorous compliance testing the HSC introduced a new complaints management<br />
system called RAEMOC in April <strong>2001</strong>. It is an Access database that is also used in<br />
the Australian Capital Territory, Tasmania and Western Australia health complaints<br />
agencies and New South Wales is assessing whether it is suitable to meet their<br />
requirements. RAEMOC provides accurate periodical reporting and allows for in<br />
depth analysis of patterns and trends from the relevant complaints data.<br />
FINANCE<br />
Statement of Understanding<br />
The HSC and the Director, Portfolio <strong>Services</strong>, DHS signed a “Statement of<br />
Understanding” which identifies the types and levels of services delivered by the<br />
office and the funding allocation necessary to deliver its statutory responsibilities and<br />
services. The document identifies service improvement initiatives, organisational and<br />
business management issues and statutory responsibilities and core business. The<br />
HSC reported how it met the targets in the <strong>2000</strong>/01 document at the end of the<br />
financial year.<br />
Evaluation Survey<br />
In February <strong>2001</strong> the HSC commenced sending evaluation survey forms to all<br />
complainants and providers at the conclusion of a complaint. These provide valuable<br />
feedback about our services, our manner and our efficiency. The forms list six<br />
questions:<br />
1. HSC staff were helpful in explaining the complaints process<br />
2. I was able to speak to HSC staff when I needed to<br />
3. HSC Staff returned my calls within 24 hours<br />
4. I felt HSC staff listened to what I had to say<br />
5. I was satisfied with the way the complaint was handled<br />
6. I was satisfied with the outcome of the complaint<br />
and respondents were asked whether they Strongly Agreed, Agreed, Disagreed or<br />
Strongly Disagreed with the question. The responses received appear in the Table 17.<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 55
Complainants<br />
Table 17. Complainants’ Evaluations<br />
Complainants' Evaluations<br />
from February <strong>2001</strong> to 30 June <strong>2001</strong><br />
Response total=105 out of 450 sent 23% return<br />
100%<br />
80%<br />
3<br />
4<br />
5<br />
1<br />
8 8<br />
11<br />
4<br />
7<br />
2 0<br />
4 11<br />
4<br />
11<br />
31<br />
10<br />
18<br />
Missing<br />
60%<br />
38<br />
44<br />
40<br />
34<br />
13<br />
Disagree strongly<br />
25<br />
Disagree<br />
40%<br />
20%<br />
52<br />
47<br />
43<br />
64<br />
49<br />
39<br />
Agree<br />
0%<br />
helpful access calls listen handled outcome<br />
Agree strongly<br />
Complainants who responded were very happy with the service provided by the HSC.<br />
Over 80% said the staff were helpful, they were able to access staff who listened to<br />
them and returned calls promptly. Seventy nine percent were satisfied with the way<br />
the complaint was handled and 61% were satisfied with the outcome of the complaint.<br />
Some comments from complainants:<br />
“I am very thankful and very grateful for the way my complaint was handled. The<br />
outcome of the complaint is what I wanted and I thank you for that.”<br />
“I was very impressed with the attention my complaint was given and also with the<br />
follow up to make sure I was happy with the outcome”.<br />
“Thank you very much for all your support throughout my difficult time. You were<br />
very helpful in informing me during this process.”<br />
“I would like to thank you once again for the way you listened to my complaint, it is a<br />
credit to your office the way you handled it.”<br />
“I could only speak very highly of your staff, the process and the healing it has bought<br />
to myself and my family.”<br />
“I appreciated your support at a time when I felt I was being treated unjustly – it is<br />
good to know support services are available to the public.”<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 56
Providers<br />
Table 18. Providers’ Evaluations<br />
Providers Evaluations<br />
from February <strong>2001</strong> to June 30 <strong>2001</strong><br />
Response total=93 out of 450 sent 21% return<br />
100%<br />
80%<br />
60%<br />
6<br />
1<br />
10<br />
2<br />
1<br />
45 40<br />
21<br />
1<br />
2<br />
30<br />
3 4<br />
10<br />
3<br />
5<br />
2<br />
2<br />
36 43 39<br />
Missing<br />
Disagree strongly<br />
Disagree<br />
40%<br />
20%<br />
39 41 39<br />
43 41 43<br />
Agree<br />
0%<br />
helpful access calls listen handled outcome<br />
Agree strongly<br />
Provider responses were also very positive. Eighty eight percent of providers who<br />
responded indicated they were satisfied with the outcome of the complaint. Over 84%<br />
of providers agreed the staff were helpful, they were able to access staff who listened<br />
to them and 74% agreed their calls were returned within 24 hours.<br />
Here are some comments that indicate the level of satisfaction providers have:<br />
“Thank you, its nice to have the HSC look after these issues; its becoming<br />
increasingly difficult to satisfy every patient and it seems complaints will become an<br />
ever present reality in medical practice and the HSC has dealt with my case well.”<br />
“I was impressed with the professionalism and the patience of the staff in a difficult<br />
and a time consuming process.”<br />
“As a health service provider I have no complaint with the current procedures of your<br />
office.”<br />
“I appreciate the chance for the complaint to be referred to me to enable an apology<br />
and for the complaint to be handled locally – which turned out to be satisfactory.”<br />
“I appreciated the opportunity to discuss the issue and the courtesy with which I was<br />
treated. I also appreciated the non-judgemental advice, likewise the feedback.”<br />
“Whilst form my point of view a satisfactory outcome was not achieved, your conduct<br />
of this matter was appreciated and approvingly managed.”<br />
While the period of evaluation was limited to 5 months the data indicate an overall<br />
satisfaction with the role of the office in complaint resolution. The evaluation process<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 57
continues and it will be interesting to review 12 months data in our next <strong>Annual</strong><br />
<strong>Report</strong>.<br />
BUDGET<br />
For the <strong>2000</strong>/<strong>2001</strong> financial year the OHSC expended $1,042,244(excluding indirect<br />
expenses) being 97% of its total allocation of $1,078,124, resulting in a surplus of<br />
$35,880. This compared to expenditure of $1,040,569 in 1999/00.<br />
Financial Statements<br />
Allocated<br />
Actual<br />
Operating Expenses $142,893 $104,803<br />
Salaries $924,831 $910,442<br />
Sub Total $1,067,724 $1,015,224<br />
Capital Expenditure $10,400 $26,999<br />
Total $1,078,124 $1,042,244<br />
Expenditure<br />
Direct Expenses<br />
Salaries $910,442<br />
Administrative stationery & operating supplies $11,973<br />
Books/publications/subscriptions/memberships $4,427<br />
Computer systems - maintenance $625<br />
Furniture, fittings & equipment $1,327<br />
Income ($17,053)<br />
Information technology costs $7,909<br />
Interpreter <strong>Services</strong> $890<br />
Legal <strong>Services</strong> $2,416<br />
Medical reports $15,353<br />
Meeting expenses $1,436<br />
Miscellaneous $6,135<br />
Postal /courier $1,554<br />
Printing $5,365<br />
Publicity & information $917<br />
Staff development & seminars $12,531<br />
Telephones $24,727<br />
Travel-Airfares, Taxis, Personal Expenses $13,752<br />
Vehicle $226<br />
Workcover $10,293<br />
Sub Total $104,803<br />
Capital Expenditure $26,999<br />
Total $1,042,244<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 58
.<br />
APENDICES<br />
APPENDIX 1 - Providers by Type<br />
Provider<br />
Total<br />
Medical Practitioners 1107<br />
Hospitals 876<br />
Dentists in Private Practice 195<br />
Remaining Providers<br />
Aboriginal <strong>Health</strong> Worker 2<br />
Acupuncturist 4<br />
Alcohol & drug service 4<br />
Alternative therapist 10<br />
Ambulance 21<br />
Appliances and Equipment 2<br />
Audiologist 2<br />
CAT Team 7<br />
Chiropodist/Podiatrist 5<br />
Chiropractor 9<br />
Community <strong>Health</strong> Centre 36<br />
Corrections <strong>Health</strong> 116<br />
Counselor 13<br />
Dental Technician 22<br />
Dept of Human <strong>Services</strong> 8<br />
Diagnostic Pathology 23<br />
Family Planning 3<br />
<strong>Health</strong> Insurance 3<br />
Hostel 8<br />
Infant Welfare Centre 1<br />
Masseur 6<br />
Naturopath 7<br />
Nurse 3<br />
Nursing Home 6<br />
Nursing Service 5<br />
Occupational therapist 1<br />
Optical Dispenser 5<br />
Optometrist 26<br />
Pharmacist 31<br />
Physiotherapist 6<br />
Psychiatric <strong>Health</strong> Centre 26<br />
Psychologist 8<br />
Radiographer 12<br />
Supported Residential Service 4 420<br />
Not specified 174<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 59
Total 2796<br />
APPENDIX 2 - Medical Practitioner Specialities<br />
Specialty<br />
Total<br />
Allergy 3<br />
Anaesthetics 21<br />
Cardiology 5<br />
Dermatology 25<br />
Ear, Nose and Throat 11<br />
Emergency Medicine 1<br />
General Surgery 49<br />
General practice 544<br />
Gastroenterology 7<br />
Neurosurgery 5<br />
Neurology 11<br />
Obstetrics/Gynecology 52<br />
Oncology 5<br />
Ophthalmology 19<br />
Orthopedic surgery 29<br />
Pediatrics 4<br />
Physical medicine 11<br />
Plastic surgery 33<br />
Psychiatry 49<br />
Pathology 3<br />
Reception/administration 7<br />
Radiology 8<br />
Rheumatology 4<br />
Urology 13<br />
Vascular surgery 2<br />
Not specified 187<br />
1107<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 60
APPENDIX 3 - HCIP Issues<br />
Access 33% Treatment 23%<br />
Absence of caring 701 Absence of caring 124<br />
Delay in admission 297 Inadequate diagnosis 315<br />
Delay in treatment 974 Inadequate treatment 730<br />
Discharge arrangements 455 Inadequate nursing care 639<br />
Discharge/transfer 211 Medication omission/error 173<br />
No/inadequate service 940 Negligent treatment 125<br />
Non attendance 26 Other 530<br />
Other 467 Rough treatment 114<br />
Refused admission 47 Unskillful/incompetent treatment 110<br />
Refused to refer 21 Unexpected outcome 186<br />
Service busy 128 Wrong diagnosis 64<br />
Transport 71 Wrong treatment 46<br />
Transfer unsuitable 19<br />
Waiting list 241<br />
Total Access 4598 Total Treatment 3156<br />
Communication 27% Rights 8%<br />
Absence of caring 115 Accuracy of records 42<br />
Conflicting information 270 Access to records 83<br />
Communication breakdown 946 Assault 68<br />
Failure to consult 147 Discrimination 160<br />
Inadequate information 553 Failure to provide an interpreter 13<br />
Other 400 No/insufficient consent 93<br />
Poor attitude/discourtesy 1129 Other 174<br />
Undignified service 82 Property 189<br />
Wrong/misleading Information 91 Privacy/confidentiality 144<br />
Refusal to treat 26<br />
Unprofessional conduct 166<br />
Total Communication 3733 Total Rights 1158<br />
Cost 3% Administration 5%<br />
Amount charged 67 Failure to provide a certificate 11<br />
Billing practice 84 Incorrect. Documentation 78<br />
Information on cost 20 No/Inadequate response 93<br />
Other 145 Other 169<br />
Private health insurance 19 Policy 101<br />
Public/private election 90 Public health standards 119<br />
Unnecessary treatment 36 Treatment Cancelled 112<br />
Total Cost 461 Total Administration 683<br />
Total 13789<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 61
APPENDIX 4 - HCIP Service Provided at time of Complaint<br />
<strong>Services</strong><br />
<strong>Services</strong><br />
Accommodation <strong>Services</strong> 192 Neurosurgery 359<br />
Administrative <strong>Services</strong> 323 Nursing Home 34<br />
Admissions 135 Nutrition 10<br />
Aged Care 435 Obstetrics 174<br />
Alcohol & drug <strong>Services</strong> 6 Obstetrics/Gynaecology 170<br />
Anaesthetics 77 Occupational Therapy 23<br />
Audiology 28 Oncology 229<br />
Awaiting admission 52 Operating Theatre 99<br />
Car Parking 184 Ophthalmology 174<br />
Cardiac Surgery 96 Orthopaedic surgery 874<br />
Cardiology 281 Outpatients clinic 479<br />
Chiropody/Podiatry 8 Paediatrics 118<br />
Colorectal 78 Pain services 17<br />
Day procedure 159 Palliative care 27<br />
Dentistry 91 Pathology 87<br />
Dermatology 85 Patient <strong>Services</strong> 117<br />
Ear, Nose & Throat 270 Pharmacy 28<br />
Emergency 2107 Physiotherapy 55<br />
Emergency Triage 252 Plastic surgery 191<br />
Endocrinology 77 Podiatry 6<br />
Environmental services 60 Prosthetics/Orthotics 17<br />
Finance & Administration 81 Psychiatry 233<br />
Food <strong>Services</strong> 49 Radiology 213<br />
Gastroenterology 321 Reception/Administration 93<br />
General medicine 1011 Rehabilitation medicine 75<br />
General practice 71 Renal/Nephrology 218<br />
General surgery 1081 Respiratory Medicine 153<br />
Genrontology 42 Rheumatology 24<br />
Gynaecology 22 Social work 73<br />
Haematology 78 Speech therapy 10<br />
Home Care 39 Specialist Medical 145<br />
Hostel 43 Specialist Surgical 54<br />
Infectious diseases 34 Spinal Injuries Unit 91<br />
Intensive Care Unit 192 Telecommunications 31<br />
Interpreter <strong>Services</strong> 7 Thalassemia<br />
Medical administration 18 Unknown 399<br />
Medical technician 6 Urology 89<br />
Neurology 344 Vascular surgery 165<br />
Total 13789<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 62
APPENDIX 5 - HCIP Outcomes<br />
Resolved 78% Change in Policy 1%<br />
Agreement reached 260 Censure or reprimand 27<br />
Apology 5165 Policy change 21<br />
Compensation Paid 66 Procedural change 71<br />
Explanation offered 2618 119<br />
Fee waived or reduced 39<br />
Fee refunded 18 Remedial 2%<br />
Frivolous/vexatious 26 Censure or Reprimand 27<br />
Information Provided 697 Remedial action 142<br />
Misunderstanding resolved 364 Caution or warning 44<br />
No further action required 112 213<br />
Service/facility provided 520<br />
Users view acknowledged 912 Referred 3%<br />
Waiting Time Reduced 20 Outcome in Referral 395<br />
10817 395<br />
Lapsed 12% Not Upheld<br />
Insufficient detail 516 Complaint not upheld 317<br />
Allowed to lapse by user 369 No action possible 336<br />
Not confirmed 207 653<br />
Unsubstantiated 382<br />
Withdrawn by user 118<br />
1592 Total 13789<br />
<strong>Health</strong> <strong>Services</strong> <strong>Commissioner</strong> <strong>Annual</strong> <strong>Report</strong> <strong>2000</strong>/<strong>2001</strong> 63